Provider Demographics
NPI:1538364971
Name:HUBER, GLORIA JEAN (LCSW)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:JEAN
Last Name:HUBER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 JANE ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-1919
Mailing Address - Country:US
Mailing Address - Phone:212-243-0707
Mailing Address - Fax:
Practice Address - Street 1:26 W 9TH ST
Practice Address - Street 2:SUITE 9E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8971
Practice Address - Country:US
Practice Address - Phone:212-243-0707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049446-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYND9321OtherEMPIRE BLUE CROSS
NYNG5151Medicare ID - Type UnspecifiedPROVIDER NUMBER