Provider Demographics
NPI:1831118173
Name:GLICK, KAREN (EDS)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:
Last Name:GLICK
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 AUGUSTA ST
Mailing Address - Street 2:
Mailing Address - City:PEQUANNOCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07440-1505
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:82 NEWARK POMPTON TPKE
Practice Address - Street 2:SUITE # 2
Practice Address - City:RIVERDALE
Practice Address - State:NJ
Practice Address - Zip Code:07457-1427
Practice Address - Country:US
Practice Address - Phone:973-706-6079
Practice Address - Fax:973-706-6079
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00012900101YA0400X
NJ37PC00076100101YM0800X
NJ37FI00148300106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health