Provider Demographics
NPI:1215789086
Name:TUCKER, NICHOLAS ISAIAH (MHC-LP)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:ISAIAH
Last Name:TUCKER
Suffix:
Gender:M
Credentials:MHC-LP
Other - Prefix:MR
Other - First Name:NICK
Other - Middle Name:ISAIAH
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MHC-LP
Mailing Address - Street 1:55 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-2739
Mailing Address - Country:US
Mailing Address - Phone:914-327-5588
Mailing Address - Fax:
Practice Address - Street 1:55 MAIN ST
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-2739
Practice Address - Country:US
Practice Address - Phone:914-327-5588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health