Provider Demographics
NPI:1457763427
Name:GLASSER, JENNIFER RACHEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:RACHEL
Last Name:GLASSER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 OCEAN PARK BLVD
Mailing Address - Street 2:SUITE #301
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-3022
Mailing Address - Country:US
Mailing Address - Phone:310-260-8653
Mailing Address - Fax:
Practice Address - Street 1:3101 OCEAN PARK BLVD
Practice Address - Street 2:SUITE #301
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-3022
Practice Address - Country:US
Practice Address - Phone:310-260-8653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25728103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist