Provider Demographics
NPI:1205991999
Name:TUCKER, SHELDON DAVID (LCSW)
Entity type:Individual
Prefix:MR
First Name:SHELDON
Middle Name:DAVID
Last Name:TUCKER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11023 72ND RD
Mailing Address - Street 2:2A
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5413
Mailing Address - Country:US
Mailing Address - Phone:718-544-2719
Mailing Address - Fax:
Practice Address - Street 1:11020 71ST RD
Practice Address - Street 2:ARISTA CENTER FOR PSYCHOTHERAPY
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4945
Practice Address - Country:US
Practice Address - Phone:718-793-3133
Practice Address - Fax:718-793-2023
Is Sole Proprietor?:No
Enumeration Date:2006-12-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR013829-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR013829-1OtherSTATE CERTIFICATION