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General NPI Number Information
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NPI Number | 1417549361
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Entity Type | Organization
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Legal Business Name | TUCKER CLINICAL PRACTICE, LCSW, P.C
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Dates
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Enumeration Date | 02/10/2021
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Last Update Date | 01/02/2024
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Provider Practice Location Address
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Address Line | 2078 PINE ST
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City | NORTH BALDWIN
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State | NY
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Zip | 11510-2619
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Country | US
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Telephone | 917-459-2431
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Fax |
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Provider Business Mailing Address
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Address Line | 2078 PINE ST
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City | NORTH BALDWIN
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State | NY
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Zip | 11510-2619
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Country | US
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Telephone | 917-459-2431
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DYNA TUCKER
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Credential |
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Telephone | 917-459-2431
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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 |
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License Number State |
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