Provider Demographics
NPI:1407911167
Name:GLUCK, PAUL HERBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:HERBERT
Last Name:GLUCK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 OAK HILL RD
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5783
Mailing Address - Country:US
Mailing Address - Phone:732-747-7428
Mailing Address - Fax:732-531-0379
Practice Address - Street 1:79 OAK HILL RD
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5783
Practice Address - Country:US
Practice Address - Phone:732-747-7428
Practice Address - Fax:732-531-0379
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ266103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical