Basic Information
| Provider Information | |||||||||
| NPI: | 1780241661 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TUCKER | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1153 BATEMAN DR | ||||||||
| Address2: | |||||||||
| City: | PHOENIXVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194605109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109839091 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 780 E MARKET ST STE 220&230 | ||||||||
| Address2: | |||||||||
| City: | WEST CHESTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193824882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108923800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2019 | ||||||||
| LastUpdateDate: | 05/25/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC1900X | PS-008664-L | PA | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Counseling |
No ID Information.