Provider Demographics
NPI:1881754943
Name:GLICK, JUDITH K (LMHC)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:K
Last Name:GLICK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:68 WEBCOWET ROAD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-2323
Mailing Address - Country:US
Mailing Address - Phone:781-646-2282
Mailing Address - Fax:781-646-1066
Practice Address - Street 1:259 MASSACHUSETTS AVENUE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-8406
Practice Address - Country:US
Practice Address - Phone:781-646-2282
Practice Address - Fax:781-646-1066
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALMHC728101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALM0470OtherBCBS OF MA
MA409808OtherMAGELLAN P CARE HARV PILG