Provider Demographics
NPI:1033532445
Name:GLASSCOCK, ALLISON MERYL (PSYD)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:MERYL
Last Name:GLASSCOCK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 E 11TH ST APT A3
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-9751
Mailing Address - Country:US
Mailing Address - Phone:917-420-0267
Mailing Address - Fax:
Practice Address - Street 1:625 E 11TH ST APT A3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-9751
Practice Address - Country:US
Practice Address - Phone:917-420-0267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-22
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019758103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03808871Medicaid
NY03808871Medicaid