MEDICARE: NORA GLUCK NORA GLUCK

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
1	1041C0700X	Clinical Social Worker	C-11775	NM

General Provider Information

NPI Number	:	1982794004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NORA GLUCK NORA GLUCK

Provider Business Mailing Address
First Line	:	600 AVENIDA VILLA HERMOSA UNIT 207
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87506-4536
Country	:	US
Telephone Number	:	203-913-8912
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 AVENIDA VILLA HERMOSA UNIT 207
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87506-4536
Country	:	US
Telephone Number	:	203-913-8912
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	06/21/2022

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