Provider Demographics
NPI:1366727356
Name:GLASS, JON ANDREW (PHD)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:ANDREW
Last Name:GLASS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E 2ND ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1537
Mailing Address - Country:US
Mailing Address - Phone:814-877-8013
Mailing Address - Fax:814-877-8007
Practice Address - Street 1:120 E 2ND ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1537
Practice Address - Country:US
Practice Address - Phone:814-877-8013
Practice Address - Fax:814-877-8007
Is Sole Proprietor?:No
Enumeration Date:2011-10-21
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1026637580001Medicaid
PA1026637580001Medicaid