Provider Demographics
NPI:1205980554
Name:MCNEIL TUCKER, ANDREA CECILE (LCSW)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:CECILE
Last Name:MCNEIL TUCKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11711 FRANCIS LEWIS BLVD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-1521
Mailing Address - Country:US
Mailing Address - Phone:917-270-5558
Mailing Address - Fax:347-594-5793
Practice Address - Street 1:11711 FRANCIS LEWIS BLVD
Practice Address - Street 2:
Practice Address - City:CAMBRIA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11411-1521
Practice Address - Country:US
Practice Address - Phone:917-270-5558
Practice Address - Fax:347-594-5793
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR053103-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY533116Medicaid
NY533116OtherVALUE OPTIONS
NY07580Medicare ID - Type UnspecifiedANDREA MCNEIL TUCKER