Provider Demographics
NPI:1942784624
Name:GLAZER, CORA JOHANNA (LMSW)
Entity Type:Individual
Prefix:
First Name:CORA
Middle Name:JOHANNA
Last Name:GLAZER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CORA
Other - Middle Name:JOHANNA
Other - Last Name:WILEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2525 WALLINGWOOD DR STE 602
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6928
Mailing Address - Country:US
Mailing Address - Phone:210-346-0787
Mailing Address - Fax:
Practice Address - Street 1:2525 WALLINGWOOD DR STE 602
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6928
Practice Address - Country:US
Practice Address - Phone:210-346-0787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX631081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical