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General NPI Number Information
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NPI Number | 1669147468
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Entity Type | Individual
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Provider Name | SARA KRISTIN TUCKER LMHC
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Gender | Female
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Dates
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Enumeration Date | 08/12/2021
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Last Update Date | 08/12/2021
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Provider Practice Location Address
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Address Line | 130 ALLENS CREEK RD
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City | ROCHESTER
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State | NY
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Zip | 14618-3305
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Country | US
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Telephone | 585-935-1396
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Fax |
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Provider Business Mailing Address
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Address Line | 6674 SAINT JOHNS PKWY
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City | VICTOR
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State | NY
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Zip | 14564-9258
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Country | US
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Telephone | 585-935-1396
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 002858
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License Number State | NY
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