Provider Demographics
NPI:1487766770
Name:GLICK, GAIL M (LCSW-C)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:M
Last Name:GLICK
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 THOMAS JOHNSON DR STE 204
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4404
Mailing Address - Country:US
Mailing Address - Phone:301-663-8343
Mailing Address - Fax:301-695-0746
Practice Address - Street 1:172 THOMAS JOHNSON DR STE 204
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4404
Practice Address - Country:US
Practice Address - Phone:301-663-8343
Practice Address - Fax:301-695-0746
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD032051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical