Provider Demographics
NPI:1912510702
Name:TUCKER, TITUS S (LCSW)
Entity Type:Individual
Prefix:MR
First Name:TITUS
Middle Name:S
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 1:530 S FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-4140
Mailing Address - Country:US
Mailing Address - Phone:954-794-6893
Mailing Address - Fax:954-421-3595
Practice Address - Street 1:505 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-4109
Practice Address - Country:US
Practice Address - Phone:954-794-6893
Practice Address - Fax:954-421-3595
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW175091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW17509OtherSTATE LICENSE