Provider Demographics
NPI:1417215831
Name:GLUZERMAN, TANYA CHRISTINA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:CHRISTINA
Last Name:GLUZERMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3381 W MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-1008
Mailing Address - Country:US
Mailing Address - Phone:708-404-0589
Mailing Address - Fax:630-377-7802
Practice Address - Street 1:3381 W MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-1008
Practice Address - Country:US
Practice Address - Phone:708-404-0589
Practice Address - Fax:630-377-7802
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008307103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical