Provider Demographics
NPI:1053068403
Name:TUCKFELT-SPEY, DARA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DARA
Middle Name:
Last Name:TUCKFELT-SPEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2433 NE 20TH TER
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-7733
Mailing Address - Country:US
Mailing Address - Phone:240-620-1254
Mailing Address - Fax:
Practice Address - Street 1:2433 NE 20TH TER
Practice Address - Street 2:
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-7733
Practice Address - Country:US
Practice Address - Phone:240-620-1254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-06
Last Update Date:2022-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8707103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist