Individual provider Active NPI

Tanya Christina Gluzerman, PSY.D.

  • Clinical Psychologist
  • Saint Charles, IL
National Provider Identifier
1417215831
Registry record updated Apr 24, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071008307 Issued in IL
Practice address
3381 W Main St
Suite 1
Saint Charles, IL 60175-1008
Phone
(708) 404-0589
Fax
(630) 377-7802
NPI assigned
Apr 24, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 24, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 071008307 IL Primary

Addresses

Primary practice location

3381 W Main St
Suite 1
Saint Charles, IL 60175-1008

Mailing address

3381 W Main St
Suite 1
Saint Charles, IL 60175-1008
Phone (708) 404-0589

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190703000017 IL Practitioner - Clinical Psychologist 8628302163 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Michael Pica PCGroup PAC ID 1254665847, 3 clinicians

Practice addresses (Care Compare)

127 S 1St St
Suite 105
Geneva, IL 60134-2644
Phone (630) 549-6497

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
071008307ILMDClinical Psychologist

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1335225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335225600000",
    "number": "1417215831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3381 W MAIN ST",
            "address_2": "SUITE 1",
            "city": "SAINT CHARLES",
            "state": "IL",
            "postal_code": "601751008",
            "telephone_number": "708-404-0589",
            "fax_number": "630-377-7802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3381 W MAIN ST",
            "address_2": "SUITE 1",
            "city": "SAINT CHARLES",
            "state": "IL",
            "postal_code": "601751008",
            "telephone_number": "708-404-0589",
            "fax_number": "630-377-7802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLUZERMAN",
        "first_name": "TANYA",
        "middle_name": "CHRISTINA",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-04-24",
        "last_updated": "2012-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071008307",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Charles, IL

Sources for this page

Verify at the official NPI Registry.