Provider Demographics
NPI:1184434003
Name:KUCKER, COREY (LSW, CAADC)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:KUCKER
Suffix:
Gender:M
Credentials:LSW, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:ROARING BROOK TWP
Mailing Address - State:PA
Mailing Address - Zip Code:18444-8209
Mailing Address - Country:US
Mailing Address - Phone:914-424-2728
Mailing Address - Fax:
Practice Address - Street 1:562 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-3721
Practice Address - Country:US
Practice Address - Phone:570-552-3760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW136443104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty