MEDICARE: MRS. SAMANTHA GLUCK OAMI LCSW

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

General Provider Information

NPI Number	:	1033866512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SAMANTHA GLUCK OAMI LCSW

Provider Business Mailing Address
First Line	:	3860 SHERIDAN ST STE C
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3624
Country	:	US
Telephone Number	:	954-593-0510
Fax Number	:

Provider Business Practice Location Address
First Line	:	3860 SHERIDAN ST STE C
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3624
Country	:	US
Telephone Number	:	954-593-0510
Fax Number	:

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

Provider Enumeration Date	:	03/04/2022
Last Update Date	:	03/04/2022

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