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NPI Code Detail

MEDICARE: MS. JANICE P. TUCKMAN LICSW

MEDICARE: MS. JANICE P. TUCKMAN LICSW
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
11041C0700XClinical Social Worker102146MA

General Provider Information

NPI Number : 1578639571
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JANICE P. TUCKMAN LICSW
Provider Business Mailing Address
First Line : 11 CHAPEL PL
Second Line :
City : WELLESLEY HILLS
State : MA
Zip : 02481-3130
Country : US
Telephone Number : 781-235-4950
Fax Number : 781-235-7176
Provider Business Practice Location Address
First Line : 11 CHAPEL PL
Second Line :
City : WELLESLEY HILLS
State : MA
Zip : 02481-3130
Country : US
Telephone Number : 781-235-4950
Fax Number : 781-235-7176
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/28/2006
Last Update Date : 07/08/2007

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