Provider Demographics
NPI:1265682439
Name:TUCKER, LORA RENE' (LMSW, CASAC)
Entity type:Individual
Prefix:MS
First Name:LORA
Middle Name:RENE'
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LMSW, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 OCEAN PKWY
Mailing Address - Street 2:#5A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-2567
Mailing Address - Country:US
Mailing Address - Phone:646-208-4448
Mailing Address - Fax:347-240-0458
Practice Address - Street 1:348 13TH ST STE 503
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-6177
Practice Address - Country:US
Practice Address - Phone:718-788-2461
Practice Address - Fax:718-788-8274
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076042104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker