Provider Demographics
NPI:1235166208
Name:GLUECKSELIG, NINA RACHEL (LISW)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:RACHEL
Last Name:GLUECKSELIG
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3161 SCARBOROUGH RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44118-4049
Mailing Address - Country:US
Mailing Address - Phone:216-321-3611
Mailing Address - Fax:216-321-0021
Practice Address - Street 1:2490 LEE BLVD STE 204
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44118-1269
Practice Address - Country:US
Practice Address - Phone:216-321-3611
Practice Address - Fax:216-321-0021
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00056191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical