Healthcare Provider Details

I. General information

NPI: 1619636925
Provider Name (Legal Business Name): KAREN TSUKADA PH.D., ABPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2021
Last Update Date: 12/14/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CCSD, 280 THE GREEN UNIVERSITY OF DELAWARE
NEWARK DE
19716
US

IV. Provider business mailing address

431 HASLETT RD
JOPPA MD
21085-4229
US

V. Phone/Fax

Practice location:
  • Phone: 302-893-0501
  • Fax:
Mailing address:
  • Phone: 302-893-0501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberB1-0000754
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: