Provider Demographics
NPI:1750988507
Name:GLASS, JAMIE SAMANTHA (LCSW)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:SAMANTHA
Last Name:GLASS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 PARK AVE S # 941255
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-1502
Mailing Address - Country:US
Mailing Address - Phone:845-325-0962
Mailing Address - Fax:
Practice Address - Street 1:228 PARK AVE S # 941255
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-1502
Practice Address - Country:US
Practice Address - Phone:845-325-0962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2024-09-27
Deactivation Date:2022-03-26
Deactivation Code:
Reactivation Date:2023-09-06
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health