Provider Demographics
NPI:1871704734
Name:GLIDDEN, RICHARD MARK (MDIV)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:MARK
Last Name:GLIDDEN
Suffix:
Gender:M
Credentials:MDIV
Other - Prefix:MR
Other - First Name:R.
Other - Middle Name:MARK
Other - Last Name:GLIDDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MDIV
Mailing Address - Street 1:26 W 9TH ST
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8971
Mailing Address - Country:US
Mailing Address - Phone:212-534-9959
Mailing Address - Fax:212-534-9959
Practice Address - Street 1:26 W 9TH ST
Practice Address - Street 2:SUITE 3A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8971
Practice Address - Country:US
Practice Address - Phone:212-534-9959
Practice Address - Fax:212-534-9959
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
NY000391106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral