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Organization
LYDIA S GLASS PHD PSYCHOLOGICAL & MEDIATION SERVICES INC
Active
Organization
LYDIA S GLASS PHD PSYCHOLOGICAL & MEDIATION SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LYDIA S GLASS (PRESIDENT)
(626) 792-4153
Entity
Organization
Contact information
Practice address
200 E DEL MAR BLVD STE 210, PASADENA, CA 91105-2551
(626) 792-4153
(626) 930-0626
Mailing address
200 E DEL MAR BLVD STE 210, PASADENA, CA 91105-2551
(626) 792-4153
(626) 930-0626
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
PSY13464
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CP13464
MEDICARE PTAN
CA
Enumeration date
04/16/2009
Last updated
04/16/2009
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