Active NPI
Robert Joseph Glass, PH.D.
- Psychologist
- Tempe, AZ
National Provider Identifier
1336297670
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 0868
- Practice address
- 4801 S Lakeshore Dr Ste 206
Tempe, AZ 85282-7157 - Phone
- (602) 809-5697
- NPI assigned
- Jan 5, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 0868 | AZ | Primary |
Addresses
Primary practice location
4801 S Lakeshore Dr Ste 206
Tempe, AZ 85282-7157
Mailing address
14636 S 23Rd St
Phoenix, AZ 85048-4321
Phone (480) 472-0600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 589575 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0868 | AZ | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1336297670",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14636 S 23RD ST",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850484321",
"telephone_number": "480-472-0600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4801 S LAKESHORE DR STE 206",
"city": "TEMPE",
"state": "AZ",
"postal_code": "852827157",
"telephone_number": "602-809-5697"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GLASS",
"first_name": "ROBERT",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-05",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "AZ",
"license": "0868",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "589575",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tempe, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.