Provider Demographics
NPI:1992438972
Name:GLUCK, SARAH (MT-BC, LSW)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:GLUCK
Suffix:
Gender:F
Credentials:MT-BC, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 N LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-2571
Mailing Address - Country:US
Mailing Address - Phone:732-994-5261
Mailing Address - Fax:
Practice Address - Street 1:216 RIVER AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4807
Practice Address - Country:US
Practice Address - Phone:732-833-3170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06702200104100000X
NJ15445225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty