Provider Demographics
NPI:1386021806
Name:TUCKER, ANDREA RUTH (LICSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:RUTH
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:R
Other - Last Name:HEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 CENTENNIAL DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-7939
Mailing Address - Country:US
Mailing Address - Phone:978-927-9410
Mailing Address - Fax:
Practice Address - Street 1:50 TOWER OFFICE PARK
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-2113
Practice Address - Country:US
Practice Address - Phone:774-375-1886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker