Provider Demographics
NPI:1770233116
Name:GLECKEL, DENISE LEE
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:LEE
Last Name:GLECKEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2119
Mailing Address - Country:US
Mailing Address - Phone:917-602-4630
Mailing Address - Fax:
Practice Address - Street 1:1182 TEANECK RD STE 103
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4838
Practice Address - Country:US
Practice Address - Phone:917-602-4630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06056000104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty