Provider Demographics
NPI:1770930422
Name:GLUCK, FREDERIC (MA)
Entity type:Individual
Prefix:
First Name:FREDERIC
Middle Name:
Last Name:GLUCK
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 HARREL STREET
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661
Mailing Address - Country:US
Mailing Address - Phone:802-888-5026
Mailing Address - Fax:802-888-6393
Practice Address - Street 1:72 HARREL STREET
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661
Practice Address - Country:US
Practice Address - Phone:802-888-5026
Practice Address - Fax:802-888-6393
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT068.0079910OtherLCMHC