Provider Demographics
NPI:1982702353
Name:MARRON, GLENN (PHD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:
Last Name:MARRON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:301 E 47TH ST
Mailing Address - Street 2:APARTMENT 19A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-2302
Mailing Address - Country:US
Mailing Address - Phone:212-922-1660
Mailing Address - Fax:212-922-1660
Practice Address - Street 1:280 MADISON AVE
Practice Address - Street 2:SUITE 805
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0801
Practice Address - Country:US
Practice Address - Phone:212-922-1669
Practice Address - Fax:212-922-1660
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008617-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical