Provider Demographics
NPI:1306081104
Name:TUCKMAN, HEATHER NICOLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:NICOLE
Last Name:TUCKMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E EVANS ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-2676
Mailing Address - Country:US
Mailing Address - Phone:610-430-1430
Mailing Address - Fax:610-344-7760
Practice Address - Street 1:105 E EVANS ST
Practice Address - Street 2:SUITE B
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-2676
Practice Address - Country:US
Practice Address - Phone:610-430-1430
Practice Address - Fax:610-344-7760
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016294103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical