Provider Demographics
NPI:1376521237
Name:KUTTLER, FAYANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:FAYANNE
Middle Name:
Last Name:KUTTLER
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:PO BOX 801936
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33280-1936
Mailing Address - Country:US
Mailing Address - Phone:954-224-0555
Mailing Address - Fax:954-840-8254
Practice Address - Street 1:2751 NE 183RD ST
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33160-2160
Practice Address - Country:US
Practice Address - Phone:305-401-5484
Practice Address - Fax:954-337-3309
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-02
Last Update Date:2018-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW001836104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ3340Medicare ID - Type Unspecified