Provider Demographics
NPI:1548236078
Name:GLUCK, DEBRA SUSAN (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:SUSAN
Last Name:GLUCK
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 MAXWELL DRIVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WALL
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-3852
Mailing Address - Country:US
Mailing Address - Phone:732-898-0764
Mailing Address - Fax:732-898-0765
Practice Address - Street 1:1704 MAXWELL DRIVE
Practice Address - Street 2:SUITE 204
Practice Address - City:WALL
Practice Address - State:NJ
Practice Address - Zip Code:07719-3852
Practice Address - Country:US
Practice Address - Phone:732-898-0764
Practice Address - Fax:732-898-0765
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC002955001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJJO38264Medicare UPIN