Provider Demographics
NPI:1891723615
Name:TUCKER, KAREN V (LISW, ACSW)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:V
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LISW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 BETA DR STE 301
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2368
Mailing Address - Country:US
Mailing Address - Phone:440-446-9696
Mailing Address - Fax:440-449-1435
Practice Address - Street 1:6700 BETA DR STE 301
Practice Address - Street 2:
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143-2368
Practice Address - Country:US
Practice Address - Phone:440-446-9696
Practice Address - Fax:440-449-1435
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHTUSW20822Medicare ID - Type Unspecified