Provider Demographics
NPI:1265567655
Name:TUCKER, CYNTHIA FELICE (PSYD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:FELICE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 ULUNIU ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2547
Mailing Address - Country:US
Mailing Address - Phone:808-227-1881
Mailing Address - Fax:808-261-7028
Practice Address - Street 1:328 ULUNIU ST
Practice Address - Street 2:SUITE 205
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2547
Practice Address - Country:US
Practice Address - Phone:808-227-1881
Practice Address - Fax:808-261-7028
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20025103TC0700X
HIPSY 1308103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical