Provider Demographics
NPI:1710149091
Name:GLUCK, MELVIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:
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 1:251 ALLISON CT
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4301
Mailing Address - Country:US
Mailing Address - Phone:201-894-5717
Mailing Address - Fax:201-894-5331
Practice Address - Street 1:251 ALLISON CT
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4301
Practice Address - Country:US
Practice Address - Phone:201-894-5717
Practice Address - Fax:201-894-5331
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2376103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical