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General NPI Number Information
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NPI Number | 1477820918
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Entity Type | Individual
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Provider Name | DENISE RENAE TUCKER LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/29/2011
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Last Update Date | 12/10/2018
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Provider Practice Location Address
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Address Line | 155-157 MOUNT PLEASANT AVE
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City | NEWARK
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State | NJ
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Zip | 07104
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Country | US
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Telephone | 973-483-1119
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Fax |
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Provider Business Mailing Address
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Address Line | 155-157 MOUNT PLEASANT AVE
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City | NEWARK
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State | NJ
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Zip | 07104
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Country | US
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Telephone | 973-483-1119
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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 | 44SC05489700
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State | NJ
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