Provider Demographics
NPI:1205097631
Name:GLICKMAN, KATHRYN ANN (MFT)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:ANN
Last Name:GLICKMAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23542 LYONS AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2560
Mailing Address - Country:US
Mailing Address - Phone:661-295-9925
Mailing Address - Fax:661-290-2795
Practice Address - Street 1:23542 LYONS AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-2560
Practice Address - Country:US
Practice Address - Phone:661-295-9925
Practice Address - Fax:661-290-2795
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC43889106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist