Provider Demographics
NPI:1548656895
Name:GLUECK, AMANDA (LCSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:GLUECK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MANDE
Other - Middle Name:
Other - Last Name:GLUECK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:3060 EL CERRITO PLZ # 545
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-4011
Mailing Address - Country:US
Mailing Address - Phone:510-846-8792
Mailing Address - Fax:
Practice Address - Street 1:3060 EL CERRITO PLZ # 545
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-4011
Practice Address - Country:US
Practice Address - Phone:510-846-8792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA294201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical