Provider Demographics
NPI:1972283646
Name:GLAZEBROOK, CATHERINE DAISY (MSED, MHC-LP)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:DAISY
Last Name:GLAZEBROOK
Suffix:
Gender:F
Credentials:MSED, MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 E 93RD ST APT 5A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1633
Mailing Address - Country:US
Mailing Address - Phone:407-435-0104
Mailing Address - Fax:
Practice Address - Street 1:175 KENT AVE APT 610
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11249-5289
Practice Address - Country:US
Practice Address - Phone:407-435-0104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY119163101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health