Jacob Drault Glickman, PSYD, MA, LPC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PS019712 Issued in PA

Practice address

4441 Sansom St
Philadelphia, PA 19104-2915

Phone

(267) 223-7931

NPI assigned

Jun 23, 2014

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1403481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758844800000",
    "number": "1689089229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4441 SANSOM ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191042915",
            "telephone_number": "267-223-7931",
            "fax_number": "267-247-3030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4441 SANSOM ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191042915",
            "telephone_number": "267-223-7931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLICKMAN",
        "first_name": "JACOB",
        "middle_name": "DRAULT",
        "name_prefix": "Dr.",
        "credential": "PSYD, MA, LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-06-23",
        "last_updated": "2025-09-26",
        "certification_date": "2025-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PA",
            "license": "PS019712",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "PA",
            "license": "PC011819",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Noa Glick, PSY.D.
• Seth Nathaniel Glick, MD
• Alexandra Glickman, PA-C
• Danny Glickman, MD
• David M. Glickman, LPC
• Jay Glickman, D.O.
• Joel D Glickman, MD
• Orli Marissa Glickman, DO
• Marc F. Glickstein, M.D.
• Jeffrey Glidden

• Clinical Psychologist in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Clinical Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.