Individual provider Active NPI

Judith I Tucker, L.S.W.

  • Counselor
  • Massillon, OH
National Provider Identifier
1235528159
Registry record updated Aug 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
S0018332 Issued in OH
Practice address
1660 Nave Rd SE
Massillon, OH 44646
Phone
(330) 837-9411
Fax
(330) 837-4603
NPI assigned
Jan 15, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X S0018332 OH Primary

Addresses

Primary practice location

1660 Nave Rd SE
Massillon, OH 44646

Mailing address

625 Cleveland Ave NW
Canton, OH 44702-1805
Phone (330) 455-0374

Other identifiers 1

IdentifierTypeStateIssuer
0294096MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
S0018332OHMDCounselor

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1421280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534723200000",
    "number": "1235528159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 CLEVELAND AVE NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447021805",
            "telephone_number": "330-455-0374",
            "fax_number": "330-453-6716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1660 NAVE RD SE",
            "city": "MASSILLON",
            "state": "OH",
            "postal_code": "44646",
            "telephone_number": "330-837-9411",
            "fax_number": "330-837-4603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUCKER",
        "first_name": "JUDITH",
        "middle_name": "I",
        "credential": "L.S.W.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-01-15",
        "last_updated": "2018-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "OH",
            "license": "S0018332",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0294096",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Massillon, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.