Provider Information for 1598821084
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PAULA TUCKER LCSW
Sex: Female
NPI: 1598821084
Last Updated: 2007-07-08
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1598821084 | ||||||||
| Enumeration Date | 2006-12-29 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 4601 DALE ROAD MODESTO, CA 95356 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 4601 DALE ROAD MODESTO, CA 95356 United States Phone: 209-735-3096 | Fax: | ||||||||
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