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General NPI Number Information
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NPI Number | 1184434003
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Entity Type | Individual
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Provider Name | COREY KUCKER LCSW, CAADC
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Gender | Male
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Dates
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Enumeration Date | 01/13/2025
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Last Update Date | 09/24/2025
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Provider Practice Location Address
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Address Line | 501 S WASHINGTON AVE STE 100
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City | SCRANTON
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State | PA
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Zip | 18505-3814
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Country | US
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Telephone | 570-941-0630
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Fax |
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Provider Business Mailing Address
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Address Line | 133 HIGHLAND RD
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City | ROARING BROOK TWP
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State | PA
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Zip | 18444-8209
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Country | US
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Telephone | 914-424-2728
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW025599
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License Number State | PA
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