Provider Demographics
NPI:1841555182
Name:TUCKER, DALE (MA)
Entity type:Individual
Prefix:MR
First Name:DALE
Middle Name:
Last Name:TUCKER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9204 FAWN CROSSING CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-2363
Mailing Address - Country:US
Mailing Address - Phone:813-784-0408
Mailing Address - Fax:
Practice Address - Street 1:9204 FAWN CROSSING CT
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-2363
Practice Address - Country:US
Practice Address - Phone:813-784-0408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH9415101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health