Provider Demographics
NPI:1053741488
Name:TUCKER, LAUREN (LCSW-R)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PASADENA PL
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-1209
Mailing Address - Country:US
Mailing Address - Phone:917-803-2264
Mailing Address - Fax:
Practice Address - Street 1:10 PASADENA PL
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-1209
Practice Address - Country:US
Practice Address - Phone:917-803-2264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-21
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
R046729-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical