Provider Demographics
NPI:1417167867
Name:TUCKER, CINDY L (PHD)
Entity Type:Individual
Prefix:DR
First Name:CINDY
Middle Name:L
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 1:2500 GRUBB RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4799
Mailing Address - Country:US
Mailing Address - Phone:302-743-5775
Mailing Address - Fax:302-475-4064
Practice Address - Street 1:2500 GRUBB RD
Practice Address - Street 2:SUITE 240
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4799
Practice Address - Country:US
Practice Address - Phone:302-743-5775
Practice Address - Fax:302-475-4064
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1-0000680103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent