Provider Demographics
NPI:1619636925
Name:TSUKADA, KAREN (PHD, ABPP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:TSUKADA
Suffix:
Gender:F
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 HASLETT RD
Mailing Address - Street 2:
Mailing Address - City:JOPPA
Mailing Address - State:MD
Mailing Address - Zip Code:21085-4229
Mailing Address - Country:US
Mailing Address - Phone:302-893-0501
Mailing Address - Fax:
Practice Address - Street 1:CCSD, 280 THE GREEN
Practice Address - Street 2:UNIVERSITY OF DELAWARE
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19716
Practice Address - Country:US
Practice Address - Phone:302-893-0501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1-0000754103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling