Provider Demographics
NPI:1629206016
Name:WEGLARZ, GARY M (LCSW)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:M
Last Name:WEGLARZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:GARY
Other - Middle Name:
Other - Last Name:WEGLARZ, LCSW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 210536
Mailing Address - Street 2:
Mailing Address - City:AUKE BAY
Mailing Address - State:AK
Mailing Address - Zip Code:99821-0536
Mailing Address - Country:US
Mailing Address - Phone:907-789-0146
Mailing Address - Fax:
Practice Address - Street 1:2770 SHERWOOD LN
Practice Address - Street 2:SUITE 2-C
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8545
Practice Address - Country:US
Practice Address - Phone:907-321-7852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK900-LCSW104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker