Provider Demographics
NPI:1457709529
Name:PHARA GLADDEN,LCSW,PLLC
Entity Type:Organization
Organization Name:PHARA GLADDEN,LCSW,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHARA
Authorized Official - Middle Name:
Authorized Official - Last Name:GLADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:845-596-8006
Mailing Address - Street 1:PO BOX 20
Mailing Address - Street 2:
Mailing Address - City:BLAUVELT
Mailing Address - State:NY
Mailing Address - Zip Code:10913-0020
Mailing Address - Country:US
Mailing Address - Phone:845-596-8006
Mailing Address - Fax:
Practice Address - Street 1:978 ROUTE 45
Practice Address - Street 2:SUITE 104
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3521
Practice Address - Country:US
Practice Address - Phone:845-596-8006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0751981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty