Provider Demographics
NPI:1154580157
Name:TUCKER, KATHERINE CODY (MSW)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:CODY
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 N ROBERTSON BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90048-1732
Mailing Address - Country:US
Mailing Address - Phone:310-890-3091
Mailing Address - Fax:323-661-9814
Practice Address - Street 1:450 N ROBERTSON BLVD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1732
Practice Address - Country:US
Practice Address - Phone:310-890-3091
Practice Address - Fax:323-661-9814
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 200681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical