Healthcare Provider Details

I. General information

NPI: 1326299082
Provider Name (Legal Business Name): ROBIN ELIZABETH GLUCK MS, MFTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 03/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 MANOR PLZ
PACIFICA CA
94044-1839
US

IV. Provider business mailing address

480 MANOR PLZ
PACIFICA CA
94044-1839
US

V. Phone/Fax

Practice location:
  • Phone: 650-355-8787
  • Fax: 650-355-8780
Mailing address:
  • Phone: 650-355-8787
  • Fax: 650-355-8780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number62996
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: