| Doctor Name: | ELLEN B. GLUCKMAN |
| NPI Number: | 1427496066 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA |
| License Number: | 000607 |
| Business Practice Address: | 6971 Main St Ste 3 Waitsfield, VT - 056736223 |
| Business Phone Number: | 8025955272 |
| Business Fax Number: | |
| Mailing Address: | 1444 Airport Rd, MORETOWN |
| State: | VT |
| Postal Code: | 056609225 |
| Phone Number: | 8025955272 |
| Fax Number: | |
| NPI Enumeration Date: | 06/05/2013 |
| NPI Last Update Date: | 03/23/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 000607 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | VT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |