Provider Demographics
NPI:1053361139
Name:GLASSMAN, CORINNE L (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CORINNE
Middle Name:L
Last Name:GLASSMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROBBINSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08691-1420
Mailing Address - Country:US
Mailing Address - Phone:609-259-3839
Mailing Address - Fax:609-259-2342
Practice Address - Street 1:13 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROBBINSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08691-1420
Practice Address - Country:US
Practice Address - Phone:609-259-3839
Practice Address - Fax:609-259-2342
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC440761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ002310801Medicaid
NJ818483M9DMedicare ID - Type Unspecified