Provider Demographics
NPI:1538207030
Name:TUCKER, JANE (PHD)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 CENTRAL PARK WEST
Mailing Address - Street 2:OFFICE 3
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3021
Mailing Address - Country:US
Mailing Address - Phone:212-724-3230
Mailing Address - Fax:
Practice Address - Street 1:295 CENTRAL PARK WEST
Practice Address - Street 2:OFFICE 3
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3021
Practice Address - Country:US
Practice Address - Phone:212-724-3230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005172103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
V239768Medicare ID - Type Unspecified