Provider Demographics
NPI:1821296930
Name:TUCKER, CAROLYN GAIL (RN, LCSW)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:GAIL
Last Name:TUCKER
Suffix:
Gender:F
Credentials:RN, LCSW
Other - Prefix:
Other - First Name:CARY
Other - Middle Name:
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, LCSW
Mailing Address - Street 1:512 E 40TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-5104
Mailing Address - Country:US
Mailing Address - Phone:512-451-5310
Mailing Address - Fax:512-451-4750
Practice Address - Street 1:100A W DEAN KEETON ST
Practice Address - Street 2:1 UNIVERSITY STATION A3500
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712-1002
Practice Address - Country:US
Practice Address - Phone:512-475-6940
Practice Address - Fax:512-471-8875
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical