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NPI Code Detail

MEDICARE: DR. MOLLY TUCKER PH.D.

MEDICARE:  DR. MOLLY  TUCKER  PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologistPSY31622CA

General Provider Information

NPI Number : 1275147316
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MOLLY TUCKER PH.D.
Provider Business Mailing Address
First Line : 536 LINDEN AVE APT 403
Second Line :
City : LONG BEACH
State : CA
Zip : 90802-2448
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 536 LINDEN AVE APT 403
Second Line :
City : LONG BEACH
State : CA
Zip : 90802-2448
Country : US
Telephone Number : 562-249-5654
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2020
Last Update Date : 09/05/2020

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Directions to “ DR. MOLLY TUCKER PH.D.” Practice Location

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