1770529521 NPI number — MR. ADAM M GLATT L.M.H.C., L.P.C.

Table of content: MR. ADAM M GLATT L.M.H.C., L.P.C. (NPI 1770529521)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770529521 NPI number — MR. ADAM M GLATT L.M.H.C., L.P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLATT
Provider First Name:
ADAM
Provider Middle Name:
M
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
L.M.H.C., L.P.C.
Provider Gender Code:
M

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:
1770529521
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4714
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDLOTHIAN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23112-0012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-302-5169
Provider Business Mailing Address Fax Number:
866-348-6656

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4920 MILLRIDGE PKWY E STE 216
Provider Second Line Business Practice Location Address:
MARKET SQUARE CENTER
Provider Business Practice Location Address City Name:
MIDLOTHIAN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23112-4857
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-302-5169
Provider Business Practice Location Address Fax Number:
866-348-6656
Provider Enumeration Date:
06/21/2006

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: 101YM0800X , with the licence number:  MH 3216 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 0701005187 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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