Basic Information
| Provider Information | |||||||||
| NPI: | 1366789737 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GLICK PSYCHIATRY. LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 DERBY RIDGE LN | ||||||||
| Address2: | |||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209102651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7073963270 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7474 GREENWAY CENTER DR | ||||||||
| Address2: | SUITE 730 | ||||||||
| City: | GREENBELT | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207703504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019823437 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2013 | ||||||||
| LastUpdateDate: | 03/13/2013 | ||||||||
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| AuthorizedOfficialLastName: | GLICK | ||||||||
| AuthorizedOfficialFirstName: | DENNIS | ||||||||
| AuthorizedOfficialMiddleName: | RICHARD | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3019823437 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | D73381 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.