Provider Demographics
NPI:1417549361
Name:TUCKER CLINICAL PRACTICE, LCSW, P.C
Entity Type:Organization
Organization Name:TUCKER CLINICAL PRACTICE, LCSW, P.C
Other - Org Name:TUCKER GROUP PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-459-2431
Mailing Address - Street 1:2078 PINE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-2619
Mailing Address - Country:US
Mailing Address - Phone:917-459-2431
Mailing Address - Fax:
Practice Address - Street 1:2078 PINE ST
Practice Address - Street 2:
Practice Address - City:NORTH BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-2619
Practice Address - Country:US
Practice Address - Phone:917-459-2431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-10
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty