Healthcare Provider Details

I. General information

NPI: 1003933938
Provider Name (Legal Business Name): ELEANOR MARIE STUCKER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 PROSPECT AVE APT 6A
HACKENSACK NJ
07601-2526
US

IV. Provider business mailing address

316 PROSPECT AVE APT 6A
HACKENSACK NJ
07601-2526
US

V. Phone/Fax

Practice location:
  • Phone: 201-525-1167
  • Fax: 201-525-1168
Mailing address:
  • Phone: 201-525-1167
  • Fax: 201-525-1168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number44SC00604000
License Number StateNJ

VII. Legacy identifiers

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

# 1
Identifier029939-1
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerSOCIAL WORK LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: