1992887889 NPI number — MRS. LOIS N GLAZER LMFT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992887889 NPI number — MRS. LOIS N GLAZER LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLAZER
Provider First Name:
LOIS
Provider Middle Name:
N
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LUCHNICK
Provider Other First Name:
LOIS
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1992887889
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 810
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTBROOK
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06498
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-399-3466
Provider Business Mailing Address Fax Number:
860-399-3466

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
49 SHERWOOD TER
Provider Second Line Business Practice Location Address:
239 WILLARD AVE WESTBROOK CT
Provider Business Practice Location Address City Name:
OLD SAYBROOK
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06475-2123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-443-4163
Provider Business Practice Location Address Fax Number:
860-399-3466
Provider Enumeration Date:
10/19/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  CTMFT000143 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)