Healthcare Provider Details

I. General information

NPI: 1952075426
Provider Name (Legal Business Name): ALEXANDRA TUCKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2021
Last Update Date: 08/06/2021
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 WASHINGTON ST STE 106
BRAINTREE MA
02184-4764
US

IV. Provider business mailing address

7 COMMONWEALTH CT APT 7
BRIGHTON MA
02135-4524
US

V. Phone/Fax

Practice location:
  • Phone: 617-471-8400
  • Fax:
Mailing address:
  • Phone: 704-299-7477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: