Provider Demographics
NPI:1326897224
Name:GLICKMAN, MARK (PHD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:GLICKMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARKUS
Other - Middle Name:
Other - Last Name:GLICKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:30 EASTWOODS LN
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-6402
Mailing Address - Country:US
Mailing Address - Phone:914-364-1614
Mailing Address - Fax:
Practice Address - Street 1:30 EASTWOODS LN
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-6402
Practice Address - Country:US
Practice Address - Phone:914-364-1614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026445103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist