Provider Demographics
NPI:1396942967
Name:TUCH, MICHAEL (LCSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:TUCH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 SW 87TH CT
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2231
Mailing Address - Country:US
Mailing Address - Phone:305-598-6640
Mailing Address - Fax:305-598-6640
Practice Address - Street 1:9000 SW 87TH CT
Practice Address - Street 2:SUITE 110
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2231
Practice Address - Country:US
Practice Address - Phone:305-598-6640
Practice Address - Fax:305-598-6640
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW51141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW5114OtherLIC NUMBER
FL1041C0700XOtherCLINICAL SW TAXONOMY
FLZ8504OtherBC BS OF FL