Basic Information
| Provider Information | |||||||||
| NPI: | 1588736417 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TUCK | ||||||||
| FirstName: | FRANCES | ||||||||
| MiddleName: | YVONNE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FISHER | ||||||||
| OtherFirstName: | FRANCES | ||||||||
| OtherMiddleName: | YVONNE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 34 ROYAL CREST DR | ||||||||
| Address2: | APT 11 | ||||||||
| City: | MARLBOROUGH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017522433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078418957 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 251 W CENTRAL ST | ||||||||
| Address2: | SUITE 25 | ||||||||
| City: | NATICK | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017603758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086534820 | ||||||||
| FaxNumber: | 5086534827 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2006 | ||||||||
| LastUpdateDate: | 08/14/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | CW017172 | PA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 432397599 | 05 | ME | MEDICAID |