Provider Demographics
NPI:1487084042
Name:GLASSMAN, LESLIE A (PSYD, LBS)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:A
Last Name:GLASSMAN
Suffix:
Gender:F
Credentials:PSYD, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 ARROWWOOD DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18302-9640
Mailing Address - Country:US
Mailing Address - Phone:570-234-9218
Mailing Address - Fax:
Practice Address - Street 1:107E SHAWNEE SQURE DR. SE
Practice Address - Street 2:
Practice Address - City:SHAWNEE ON DELAWARE
Practice Address - State:PA
Practice Address - Zip Code:18356
Practice Address - Country:US
Practice Address - Phone:570-369-4991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-19
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH000497103K00000X
103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst