Provider Demographics
NPI:1629124367
Name:TUCKER, KAREN MARIE (BSED)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:MARIE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:BSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 FOSTER ST
Mailing Address - Street 2:NONE
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-3106
Mailing Address - Country:US
Mailing Address - Phone:617-912-7648
Mailing Address - Fax:
Practice Address - Street 1:530 BORDER ST
Practice Address - Street 2:
Practice Address - City:EAST BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-2432
Practice Address - Country:US
Practice Address - Phone:617-569-6560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator