Provider Demographics
NPI:1093526485
Name:TUCHMAN, STEPHANIE ANGELICA
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANGELICA
Last Name:TUCHMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROADWAY
Mailing Address - State:NC
Mailing Address - Zip Code:27505-9500
Mailing Address - Country:US
Mailing Address - Phone:336-314-7480
Mailing Address - Fax:
Practice Address - Street 1:127 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BROADWAY
Practice Address - State:NC
Practice Address - Zip Code:27505-9500
Practice Address - Country:US
Practice Address - Phone:336-314-7480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician