Provider Demographics
NPI:1477820918
Name:TUCKER, DENISE RENAE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:RENAE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155-157 MOUNT PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104
Mailing Address - Country:US
Mailing Address - Phone:973-483-1119
Mailing Address - Fax:
Practice Address - Street 1:155-157 MOUNT PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104
Practice Address - Country:US
Practice Address - Phone:973-483-1119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-29
Last Update Date:2018-12-10
Deactivation Date:2018-12-06
Deactivation Code:
Reactivation Date:2018-12-10
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054897001041C0700X
NJ261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical