Provider Demographics
NPI:1235305632
Name:DUCKRO, PAUL NICHOLAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:NICHOLAS
Last Name:DUCKRO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7140 E RIVER CANYON PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-2109
Mailing Address - Country:US
Mailing Address - Phone:520-349-0615
Mailing Address - Fax:
Practice Address - Street 1:2101 N COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-2845
Practice Address - Country:US
Practice Address - Phone:520-349-0615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3514103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist