Provider Demographics
NPI:1659339810
Name:GERALD A. GLUCK, PH.D,LMFT,PA
Entity Type:Organization
Organization Name:GERALD A. GLUCK, PH.D,LMFT,PA
Other - Org Name:CENTER FOR FAMILY COUNSELING & BIOFEEDBACK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:GLUCK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMFT
Authorized Official - Phone:954-227-0551
Mailing Address - Street 1:5401 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4636
Mailing Address - Country:US
Mailing Address - Phone:954-227-0551
Mailing Address - Fax:954-227-0592
Practice Address - Street 1:5401 N UNIVERSITY DR
Practice Address - Street 2:SUITE 104
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-4636
Practice Address - Country:US
Practice Address - Phone:954-227-0551
Practice Address - Fax:954-227-0592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1223106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMT1223OtherLICENSE