Provider Demographics
NPI:1831269786
Name:GLATTHORN, TERESA ANN (PSYD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:ANN
Last Name:GLATTHORN
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 1:3 FIREWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-1733
Mailing Address - Country:US
Mailing Address - Phone:215-672-6627
Mailing Address - Fax:
Practice Address - Street 1:349 YORK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-2660
Practice Address - Country:US
Practice Address - Phone:215-672-6627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-06773-L103T00000X, 103TC0700X
PAPA-06773-L103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA603407Medicare PIN