Provider Demographics
NPI:1447653449
Name:GLUCK, JESSICA (BCBA)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:GLUCK
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:GOAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BCBA
Mailing Address - Street 1:40 GRANT AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-3107
Mailing Address - Country:US
Mailing Address - Phone:917-685-8798
Mailing Address - Fax:
Practice Address - Street 1:40 GRANT AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-3107
Practice Address - Country:US
Practice Address - Phone:917-685-8798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-13-13876103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst