Provider Demographics
NPI:1730855438
Name:TUCKER, TARA (LMSW)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 MURPHY RD
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:VT
Mailing Address - Zip Code:05060-8886
Mailing Address - Country:US
Mailing Address - Phone:802-236-4882
Mailing Address - Fax:
Practice Address - Street 1:177 MURPHY RD
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:VT
Practice Address - Zip Code:05060-8886
Practice Address - Country:US
Practice Address - Phone:802-236-4882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-22
Last Update Date:2021-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT156.0133916104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty