Provider Demographics
NPI:1710700190
Name:YELICH, GLENN A (SCHOOL PSYCHOLOGIST)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:A
Last Name:YELICH
Suffix:
Gender:M
Credentials:SCHOOL PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BUILDING BLOCKS LEARNING CENTER
Mailing Address - Street 2:#19 ROBINSON ROAD
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BUILDING BLOCKS LEARNING CENTER
Practice Address - Street 2:#19 ROBINSON ROAD
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323
Practice Address - Country:US
Practice Address - Phone:315-853-6090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314644901103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool