Douglas Adam Glick, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904006368 Issued in VA

Practice address

310 W Front St Ste 405
Traverse City, MI 49684-2279

Phone

(231) 518-9258

Fax

(231) 216-2793

NPI assigned

Nov 3, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604448000000",
    "number": "1770662496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 W FRONT ST STE 405",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842279",
            "telephone_number": "231-518-9258",
            "fax_number": "231-216-2793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 W FRONT ST STE 405",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842279",
            "telephone_number": "231-518-9258",
            "fax_number": "231-216-2793"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3900 W Broad St",
            "address_purpose": "LOCATION",
            "city": "Richmond",
            "state": "VA",
            "postal_code": "232303958",
            "country_code": "US",
            "telephone_number": "804-256-9689 x1289",
            "fax_number": "804-353-3061",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GLICK",
        "first_name": "DOUGLAS",
        "middle_name": "ADAM",
        "name_prefix": "Mr.",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-03",
        "last_updated": "2020-11-04",
        "certification_date": "2020-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904006368",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PTAN",
            "identifier": "C05700",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010326435",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pamela S. Gilmartin, OD
• Shannon Gilzene
• Gillian Suzanne Gines
• Kelly Gingras, NURSE PRACTITIONER
• Ramsi Anne Ginzel
• Cynthia L Glines, M.D.
• Bracey Darchael Glotzhober, LLPC
• David Neil Gloudemans
• Jessica Marie Glowacki
• Sherry Gobaleza

• Clinical Social Worker in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2020; 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.