Provider Demographics
NPI:1366687493
Name:GLUCK, DEBRA
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:GLUCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 TERRACE CIR
Mailing Address - Street 2:1C
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4161
Mailing Address - Country:US
Mailing Address - Phone:516-482-1379
Mailing Address - Fax:
Practice Address - Street 1:3 TERRACE CIR
Practice Address - Street 2:1C
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4161
Practice Address - Country:US
Practice Address - Phone:516-482-1379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010748-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist