Provider Demographics
NPI:1669147468
Name:TUCKER, SARA KRISTIN (LMHC)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:KRISTIN
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6674 SAINT JOHNS PKWY
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-9258
Mailing Address - Country:US
Mailing Address - Phone:585-935-1396
Mailing Address - Fax:
Practice Address - Street 1:130 ALLENS CREEK RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3305
Practice Address - Country:US
Practice Address - Phone:585-935-1396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002858101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty