Individual
JEFFREY TUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
2130 MILLBURN AVE, MAPLEWOOD, NJ 07040-3725
(646) 382-7410
Mailing address
PO BOX 874, HILLSIDE, NJ 07205-0874
(646) 382-7410
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
44SC05762700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0663123
—
NJ
Enumeration date
01/28/2021
Last updated
01/28/2021
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