Provider Demographics
NPI:1497385074
Name:TUCCI, LYNN
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:TUCCI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 SPRINGBROOK RD E
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-9197
Mailing Address - Country:US
Mailing Address - Phone:201-281-4059
Mailing Address - Fax:
Practice Address - Street 1:191 WOODPORT RD STE 209
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-2645
Practice Address - Country:US
Practice Address - Phone:973-512-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00223100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional