Provider Demographics
NPI:1639435605
Name:TUCKER, DAJZEE CYPRIANA (ASW)
Entity Type:Individual
Prefix:
First Name:DAJZEE
Middle Name:CYPRIANA
Last Name:TUCKER
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 W 3RD ST
Mailing Address - Street 2:8
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-2720
Mailing Address - Country:US
Mailing Address - Phone:310-346-4334
Mailing Address - Fax:
Practice Address - Street 1:11705 ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262
Practice Address - Country:US
Practice Address - Phone:323-568-4979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-04
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1512013461Medicaid
CA1512013461Medicaid
CA1512013461Medicare PIN