Provider Demographics
NPI:1750674073
Name:GLUCKSMAN, MALKA (LCSW)
Entity Type:Individual
Prefix:
First Name:MALKA
Middle Name:
Last Name:GLUCKSMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 BISMARCK STREET
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08757
Mailing Address - Country:US
Mailing Address - Phone:516-888-0441
Mailing Address - Fax:718-787-9598
Practice Address - Street 1:75 MONTIBELLO RD
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901
Practice Address - Country:US
Practice Address - Phone:845-523-9500
Practice Address - Fax:718-787-9598
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-19
Last Update Date:2024-03-07
Deactivation Date:2022-08-31
Deactivation Code:
Reactivation Date:2024-03-07
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NY0812901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health