Provider Demographics
NPI:1881004919
Name:GLUSZIK, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:GLUSZIK
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 1:100 DEBARTOLO PL STE 220
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6095
Mailing Address - Country:US
Mailing Address - Phone:330-965-7828
Mailing Address - Fax:
Practice Address - Street 1:100 DEBARTOLO PL STE 220
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-6095
Practice Address - Country:US
Practice Address - Phone:330-965-7828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3151549103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool