Provider Demographics
NPI:1750395901
Name:GLUCKIN, BARBARA (PSYD)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:GLUCKIN
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 1:30 BARSTOW RD APT 3E
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2221
Mailing Address - Country:US
Mailing Address - Phone:917-715-1236
Mailing Address - Fax:
Practice Address - Street 1:22 PARK PL
Practice Address - Street 2:STE B
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5012
Practice Address - Country:US
Practice Address - Phone:917-715-1236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY13999103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0281EPOtherMEDICARE GHI
NY02513784Medicaid
NY02513784Medicaid