Healthcare Provider Details

I. General information

NPI: 1992438972
Provider Name (Legal Business Name): SARAH GLUCK MT-BC, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 RIVER AVE
LAKEWOOD NJ
08701-4807
US

IV. Provider business mailing address

707 N LAKE DR
LAKEWOOD NJ
08701-2571
US

V. Phone/Fax

Practice location:
  • Phone: 732-833-3170
  • Fax:
Mailing address:
  • Phone: 732-994-5261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL06702200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number15445
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: