Provider Demographics
NPI:1386241230
Name:TUCKER, ROSEANNE (LCSW)
Entity type:Individual
Prefix:
First Name:ROSEANNE
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 MORGANS LN
Mailing Address - Street 2:
Mailing Address - City:COMSTOCK
Mailing Address - State:NY
Mailing Address - Zip Code:12821-1812
Mailing Address - Country:US
Mailing Address - Phone:914-755-9911
Mailing Address - Fax:
Practice Address - Street 1:12 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FORT EDWARD
Practice Address - State:NY
Practice Address - Zip Code:12828-1734
Practice Address - Country:US
Practice Address - Phone:914-755-9911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0949491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical