Provider Demographics
NPI:1922212208
Name:GLUCK, ANN JUDITH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:JUDITH
Last Name:GLUCK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 LINDLEY RD
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-2802
Mailing Address - Country:US
Mailing Address - Phone:215-576-7776
Mailing Address - Fax:
Practice Address - Street 1:26 SUMMIT GROVE AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3230
Practice Address - Country:US
Practice Address - Phone:215-576-7776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-005505-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical