Provider Demographics
NPI:1023007051
Name:TUCKER, CHERYL S (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:S
Last Name:TUCKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 W 62ND ST APT 29C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7534
Mailing Address - Country:US
Mailing Address - Phone:518-744-4161
Mailing Address - Fax:
Practice Address - Street 1:160 W 62ND ST APT 29C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7534
Practice Address - Country:US
Practice Address - Phone:518-744-4161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009443103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R55774Medicare UPIN
NY51640 BMedicare ID - Type Unspecified