MEDICARE: PAULINA GLUCK PSYD

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	103TM1800X	Intellectual & Developmental Disabilities Psychologist	PSY34432	CA

General Provider Information

NPI Number	:	1477429777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULINA GLUCK PSYD

Provider Business Mailing Address
First Line	:	12459 SADDLERIDGE CT
Second Line	:
City	:	SANTA ROSA VALLEY
State	:	CA
Zip	:	93012-9341
Country	:	US
Telephone Number	:	805-698-5611
Fax Number	:

Provider Business Practice Location Address
First Line	:	2730 WILSHIRE BLVD STE 425
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-4747
Country	:	US
Telephone Number	:	949-694-5700
Fax Number	:

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

Provider Enumeration Date	:	10/14/2025
Last Update Date	:	10/14/2025

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