Provider Demographics
NPI:1851057863
Name:TUCKER, MORRISSA (LSW)
Entity Type:Individual
Prefix:
First Name:MORRISSA
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 W JERSEY ST APT 12N
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-1362
Mailing Address - Country:US
Mailing Address - Phone:908-342-4387
Mailing Address - Fax:
Practice Address - Street 1:7 GLENWOOD AVE STE 101
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-1041
Practice Address - Country:US
Practice Address - Phone:862-233-5878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-14
Last Update Date:2021-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06656600104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker