Provider Demographics
NPI:1720796576
Name:MICHELLE GLANTZ, PH.D.
Entity Type:Organization
Organization Name:MICHELLE GLANTZ, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GLANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:917-655-2363
Mailing Address - Street 1:13450 BAYLISS RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-1833
Mailing Address - Country:US
Mailing Address - Phone:917-655-2363
Mailing Address - Fax:
Practice Address - Street 1:11980 SAN VICENTE BLVD STE 711
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-6605
Practice Address - Country:US
Practice Address - Phone:917-655-2363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)