Healthcare Provider Details

I. General information

NPI: 1184434003
Provider Name (Legal Business Name): COREY KUCKER LCSW, CAADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S WASHINGTON AVE STE 100
SCRANTON PA
18505-3814
US

IV. Provider business mailing address

133 HIGHLAND RD
ROARING BROOK TWP PA
18444-8209
US

V. Phone/Fax

Practice location:
  • Phone: 570-941-0630
  • Fax:
Mailing address:
  • Phone: 914-424-2728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW025599
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: