Provider Demographics
NPI:1629437934
Name:TUTTLE, ANDREA (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:TUTTLE
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1473 BARCELONA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-6642
Mailing Address - Country:US
Mailing Address - Phone:919-923-4633
Mailing Address - Fax:
Practice Address - Street 1:1473 BARCELONA AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-6642
Practice Address - Country:US
Practice Address - Phone:919-923-4633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW111471041C0700X
NCC0090671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical