Provider Demographics
NPI:1932240843
Name:GLIMMERGLASS COUNSELING, LLC
Entity Type:Organization
Organization Name:GLIMMERGLASS COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MCNAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:732-899-8288
Mailing Address - Street 1:1648 BAY AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PT. PLEASANT BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:08742
Mailing Address - Country:US
Mailing Address - Phone:732-899-8288
Mailing Address - Fax:732-899-6962
Practice Address - Street 1:1648 BAY AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:PT. PLEASANT BEACH
Practice Address - State:NJ
Practice Address - Zip Code:08742
Practice Address - Country:US
Practice Address - Phone:732-899-8288
Practice Address - Fax:732-899-6962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00424300103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty