Provider Demographics
NPI:1184980641
Name:GLAZER, JOHN CHAPIN (PSYD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:CHAPIN
Last Name:GLAZER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S JACKSON ST
Mailing Address - Street 2:SUITE 520
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-3176
Mailing Address - Country:US
Mailing Address - Phone:720-722-1636
Mailing Address - Fax:
Practice Address - Street 1:300 S JACKSON ST
Practice Address - Street 2:SUITE 520
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-3176
Practice Address - Country:US
Practice Address - Phone:720-722-1636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3670103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical