Basic Information
| Provider Information | |||||||||
| NPI: | 1265682439 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TUCKER | ||||||||
| FirstName: | LORA | ||||||||
| MiddleName: | RENE' | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LMSW, CASAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 135 OCEAN PKWY | ||||||||
| Address2: | #5A | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112182567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6462084448 | ||||||||
| FaxNumber: | 3472400458 | ||||||||
| Practice Location | |||||||||
| Address1: | 348 13TH ST STE 503 | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112156177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187882461 | ||||||||
| FaxNumber: | 7187888274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2008 | ||||||||
| LastUpdateDate: | 11/15/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 076042 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.