Provider Demographics
NPI:1871965392
Name:GLASSMAN, JESSE (PSYD)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:
Last Name:GLASSMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 OLD HOOK RD. SUITE 203
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675
Mailing Address - Country:US
Mailing Address - Phone:201-664-2670
Mailing Address - Fax:201-664-9605
Practice Address - Street 1:354 OLD HOOK RD. SUITE 203
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675
Practice Address - Country:US
Practice Address - Phone:201-664-2670
Practice Address - Fax:201-664-9605
Is Sole Proprietor?:No
Enumeration Date:2015-10-23
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00548400103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical