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General NPI Number Information
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NPI Number | 1821296930
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Entity Type | Individual
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Provider Name | CAROLYN GAIL TUCKER RN., LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 07/10/2007
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Provider Practice Location Address
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Address Line | 100A W DEAN KEETON ST 1 UNIVERSITY STATION A3500
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City | AUSTIN
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State | TX
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Zip | 78712-1002
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Country | US
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Telephone | 512-475-6940
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Fax | 512-471-8875
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Provider Business Mailing Address
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Address Line | 512 E 40TH ST
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City | AUSTIN
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State | TX
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Zip | 78751-5104
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Country | US
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Telephone | 512-451-5310
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Fax | 512-451-4750
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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 | 36306
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License Number State | TX
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