Provider Demographics
NPI:1104164235
Name:GLICK, KATHERINE (LPC, CCS, ACS)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:GLICK
Suffix:
Gender:
Credentials:LPC, CCS, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 BELGRADE ST FL 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-2621
Mailing Address - Country:US
Mailing Address - Phone:631-252-0667
Mailing Address - Fax:
Practice Address - Street 1:430 BELGRADE ST FL 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-2621
Practice Address - Country:US
Practice Address - Phone:215-469-1155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-24
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009315101YP2500X
NJ37LC00180700101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional