Provider Demographics
NPI:1053370403
Name:GLICK, RANA Y (MA, LMFT)
Entity type:Individual
Prefix:MS
First Name:RANA
Middle Name:Y
Last Name:GLICK
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 BLUE BIRD LN
Mailing Address - Street 2:
Mailing Address - City:PORT MATILDA
Mailing Address - State:PA
Mailing Address - Zip Code:16870-7412
Mailing Address - Country:US
Mailing Address - Phone:814-231-4086
Mailing Address - Fax:814-231-1895
Practice Address - Street 1:215 BLUE BIRD LN
Practice Address - Street 2:
Practice Address - City:PORT MATILDA
Practice Address - State:PA
Practice Address - Zip Code:16870-7412
Practice Address - Country:US
Practice Address - Phone:814-231-4086
Practice Address - Fax:814-231-1895
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000008106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist