Provider Demographics
NPI:1396063558
Name:GLENN J. MAARSE, PH.D. LLC
Entity type:Organization
Organization Name:GLENN J. MAARSE, PH.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:MAARSE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:206-323-3243
Mailing Address - Street 1:124 E EDGAR ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3132
Mailing Address - Country:US
Mailing Address - Phone:206-323-3243
Mailing Address - Fax:206-407-3243
Practice Address - Street 1:124 E EDGAR ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3132
Practice Address - Country:US
Practice Address - Phone:206-323-3243
Practice Address - Fax:206-407-3243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY2011103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA217000767Medicare PIN