MEDICARE: MS. MICHELLE RENEE TUCKER MSW

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
1	1041C0700X	Clinical Social Worker	12379	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	600007429	OTHER	MD	MAGELLEN HEALTHCARE
2	11605292	OTHER	MH	CAQH
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790710432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE RENEE TUCKER MSW

Provider Business Mailing Address
First Line	:	6618 WANING MOON WAY APT 732
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-4948
Country	:	US
Telephone Number	:	443-300-6260
Fax Number	:

Provider Business Practice Location Address
First Line	:	6618 WANING MOON WAY APT 732
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-4948
Country	:	US
Telephone Number	:	443-300-6260
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	08/12/2025

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