Provider Demographics
NPI:1992887889
Name:GLAZER, LOIS N (LMFT)
Entity type:Individual
Prefix:MRS
First Name:LOIS
Middle Name:N
Last Name:GLAZER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:LOIS
Other - Middle Name:
Other - Last Name:LUCHNICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 810
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06498
Mailing Address - Country:US
Mailing Address - Phone:860-399-3466
Mailing Address - Fax:860-399-3466
Practice Address - Street 1:49 SHERWOOD TER
Practice Address - Street 2:239 WILLARD AVE WESTBROOK CT
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-2123
Practice Address - Country:US
Practice Address - Phone:860-443-4163
Practice Address - Fax:860-399-3466
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCTMFT000143106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist