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NPI Code Detail

MEDICARE: GERALD A. GLUCK, PH.D,LMFT,PA

MEDICARE: GERALD A. GLUCK, PH.D,LMFT,PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMT1223FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MT1223OTHERFLLICENSE

General Provider Information

NPI Number : 1659339810
Entity Type Code : Organization
Provider Name (Legal Business Name) : GERALD A. GLUCK, PH.D,LMFT,PA
Provider Business Mailing Address
First Line : 5401 N UNIVERSITY DR
Second Line : SUITE 104
City : CORAL SPRINGS
State : FL
Zip : 33067-4636
Country : US
Telephone Number : 954-227-0551
Fax Number : 954-227-0592
Provider Business Practice Location Address
First Line : 5401 N UNIVERSITY DR
Second Line : SUITE 104
City : CORAL SPRINGS
State : FL
Zip : 33067-4636
Country : US
Telephone Number : 954-227-0551
Fax Number : 954-227-0592
Authorized Official
Title or Position : OWNER
Name : GERALD A GLUCK
Credential : PH.D., LMFT
Telephone Number : 954-227-0551
Provider Enumeration Date : 05/03/2006
Last Update Date : 07/31/2008

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