Provider Demographics
NPI:1730540014
Name:TUCKER THAI, ADDYSON R (PSYD)
Entity type:Individual
Prefix:DR
First Name:ADDYSON
Middle Name:R
Last Name:TUCKER THAI
Suffix:
Gender:X
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MEGAN
Other - Middle Name:A
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:22 PARSONAGE ST # 159
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4732
Mailing Address - Country:US
Mailing Address - Phone:401-216-7877
Mailing Address - Fax:401-489-7909
Practice Address - Street 1:22 PARSONAGE ST # 159
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4758
Practice Address - Country:US
Practice Address - Phone:401-216-7877
Practice Address - Fax:401-489-7909
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-14
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS01864103TC0700X
MA10739103TC0700X
NH1326103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical