Healthcare Provider Details

I. General information

NPI: 1053741488
Provider Name (Legal Business Name): LAUREN TUCKER LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2013
Last Update Date: 11/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PASADENA PL
SPRING VALLEY NY
10977-1209
US

IV. Provider business mailing address

10 PASADENA PL
SPRING VALLEY NY
10977-1209
US

V. Phone/Fax

Practice location:
  • Phone: 917-803-2264
  • Fax:
Mailing address:
  • Phone: 917-803-2264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR046729-1
License Number State

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: