Provider Demographics
NPI:1851622278
Name:TUCKER-ZAZA, MIATTA M (MSW, LICSW, LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:MIATTA
Middle Name:M
Last Name:TUCKER-ZAZA
Suffix:
Gender:F
Credentials:MSW, LICSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 HOWARD RD SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-5805
Mailing Address - Country:US
Mailing Address - Phone:202-698-2399
Mailing Address - Fax:202-698-2466
Practice Address - Street 1:821 HOWARD RD SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-5805
Practice Address - Country:US
Practice Address - Phone:202-698-2399
Practice Address - Fax:202-698-2466
Is Sole Proprietor?:No
Enumeration Date:2010-01-25
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500791621041C0700X
MD156521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical