Individual
MR. THEODORE E GLACKMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.ED.
Contact information
Practice address
100 S BROAD ST, 17TH FLOOR, PHILADELPHIA, PA 19110-1023
(267) 474-9417
Mailing address
517 E SPRING AVE, ARDMORE, PA 19003-3123
(215) 701-1560
(215) 701-1572
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS004176L
PA
Other
Enumeration date
01/07/2009
Last updated
01/07/2009
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