1588736417 NPI number — MRS. FRANCES YVONNE TUCK LCSW

Table of content: MRS. FRANCES YVONNE TUCK LCSW (NPI 1588736417)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588736417 NPI number — MRS. FRANCES YVONNE TUCK LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TUCK
Provider First Name:
FRANCES
Provider Middle Name:
YVONNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FISHER
Provider Other First Name:
FRANCES
Provider Other Middle Name:
YVONNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1588736417
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
34 ROYAL CREST DR
Provider Second Line Business Mailing Address:
APT 11
Provider Business Mailing Address City Name:
MARLBOROUGH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01752-2433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-841-8957
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
251 W CENTRAL ST
Provider Second Line Business Practice Location Address:
SUITE 25
Provider Business Practice Location Address City Name:
NATICK
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01760-3758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-653-4820
Provider Business Practice Location Address Fax Number:
508-653-4827
Provider Enumeration Date:
11/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  CW017172 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 432397599 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




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