Healthcare Provider Details

I. General information

NPI: 1992139968
Provider Name (Legal Business Name): PAULINE TERESA SCHUCK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2013
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6326 VOYAGERS PL
APOLLO BEACH FL
33572-1724
US

IV. Provider business mailing address

PO BOX 2073
RIVERVIEW FL
33568-2073
US

V. Phone/Fax

Practice location:
  • Phone: 813-466-4632
  • Fax:
Mailing address:
  • Phone: 813-405-8289
  • Fax: 813-405-8289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW8579
License Number StateFL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: