Provider Demographics
NPI:1649256868
Name:TUCCIO, ELAINE GRACE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:GRACE
Last Name:TUCCIO
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 1:3660 STONERIDGE RD
Mailing Address - Street 2:#101
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-7760
Mailing Address - Country:US
Mailing Address - Phone:512-328-7900
Mailing Address - Fax:512-732-2158
Practice Address - Street 1:3660 STONERIDGE RD
Practice Address - Street 2:#101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-7760
Practice Address - Country:US
Practice Address - Phone:512-328-7900
Practice Address - Fax:512-732-2158
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS11151101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS60RMedicare ID - Type UnspecifiedLCSW