Provider Demographics
NPI:1760779235
Name:TUCKER, DEBORAH NAOMI (MSW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:NAOMI
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 ORCHARD LAKE RD.
Mailing Address - Street 2:#426
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3027
Mailing Address - Country:US
Mailing Address - Phone:248-470-2778
Mailing Address - Fax:
Practice Address - Street 1:7001 ORCHARD LAKE RD.
Practice Address - Street 2:#426
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3027
Practice Address - Country:US
Practice Address - Phone:248-470-2778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
102L00000X
MI6801033432104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst