Provider Demographics
NPI:1881657112
Name:GLANZ, LAWRENCE MARK (PH D)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:MARK
Last Name:GLANZ
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 NORTH CRAIG STREET
Mailing Address - Street 2:SUITE 170
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213
Mailing Address - Country:US
Mailing Address - Phone:412-687-8700
Mailing Address - Fax:412-687-6808
Practice Address - Street 1:155 NORTH CRAIG STREET
Practice Address - Street 2:SUITE 170
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213
Practice Address - Country:US
Practice Address - Phone:412-687-8700
Practice Address - Fax:412-687-6808
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003286L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014932200002Medicaid
PA279970OtherVALUE OPTIONS NON PAR
PA045720OtherGALAXY HEALTH NETWORK
PA170328OtherACS MHN CLAIMS
PA162753OtherHIGHMARK INC
PA4563150OtherAETNA
PA1933612OtherFIRST HEALTH
PA0014932200002Medicaid
PA045720OtherGALAXY HEALTH NETWORK