Provider Demographics
NPI:1740264282
Name:GLEZERMAN, ANASTASYA (PHD)
Entity type:Individual
Prefix:DR
First Name:ANASTASYA
Middle Name:
Last Name:GLEZERMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3476 MONTEREY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-4059
Mailing Address - Country:US
Mailing Address - Phone:510-258-2976
Mailing Address - Fax:206-202-3880
Practice Address - Street 1:3476 MONTEREY BLVD
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-4059
Practice Address - Country:US
Practice Address - Phone:510-258-2976
Practice Address - Fax:206-202-3880
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17626103G00000X, 103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL176260Medicare ID - Type UnspecifiedMEDICARE PROVIDER #