Provider Demographics
NPI:1194074872
Name:GLICKMAN, KIM (LCSW, PHD)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:GLICKMAN
Suffix:
Gender:F
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 E BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-1801
Mailing Address - Country:US
Mailing Address - Phone:718-795-3989
Mailing Address - Fax:
Practice Address - Street 1:7 PONDFIELD RD STE 205
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-3781
Practice Address - Country:US
Practice Address - Phone:718-795-3989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-10
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0761981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical