Provider Demographics
NPI:1194720961
Name:GLANTZ, KALMAN (PHD, LMHC)
Entity type:Individual
Prefix:
First Name:KALMAN
Middle Name:
Last Name:GLANTZ
Suffix:
Gender:M
Credentials:PHD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 KINNAIRD ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3733
Mailing Address - Country:US
Mailing Address - Phone:617-876-6253
Mailing Address - Fax:
Practice Address - Street 1:12 KINNAIRD ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3733
Practice Address - Country:US
Practice Address - Phone:617-876-6253
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA181101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health