Provider Demographics
NPI:1578639571
Name:TUCKMAN, JANICE P (LICSW)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:P
Last Name:TUCKMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CHAPEL PL
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:02481-3130
Mailing Address - Country:US
Mailing Address - Phone:781-235-4950
Mailing Address - Fax:781-235-7176
Practice Address - Street 1:11 CHAPEL PL
Practice Address - Street 2:
Practice Address - City:WELLESLEY HILLS
Practice Address - State:MA
Practice Address - Zip Code:02481-3130
Practice Address - Country:US
Practice Address - Phone:781-235-4950
Practice Address - Fax:781-235-7176
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1021461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical