Provider Demographics
NPI:1063763738
Name:TUCKER, MELINDA ROBIN (LCSW)
Entity type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:ROBIN
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:ROBIN
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4016 CRESTWOOD MANOR DR
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-9006
Mailing Address - Country:US
Mailing Address - Phone:321-626-6550
Mailing Address - Fax:
Practice Address - Street 1:306 W MAIN ST STE 512
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-1840
Practice Address - Country:US
Practice Address - Phone:574-546-1900
Practice Address - Fax:574-546-1999
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-21
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN93151041C0700X
FLSW93401041C0700X
KY2586401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical