1205097631 NPI number — MRS. KATHRYN ANN GLICKMAN M.F.T.

Table of content: MRS. KATHRYN ANN GLICKMAN M.F.T. (NPI 1205097631)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205097631 NPI number — MRS. KATHRYN ANN GLICKMAN M.F.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLICKMAN
Provider First Name:
KATHRYN
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.F.T.
Provider Gender Code:
F

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1205097631
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23542 LYONS AVE
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
SANTA CLARITA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91321-2560
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-295-9925
Provider Business Mailing Address Fax Number:
661-290-2795

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23542 LYONS AVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
SANTA CLARITA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91321-2560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-295-9925
Provider Business Practice Location Address Fax Number:
661-290-2795
Provider Enumeration Date:
06/18/2008

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:  MFC43889 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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