Provider Demographics
NPI:1851787485
Name:TUTTLE, JUSTIN J (BCABA)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:J
Last Name:TUTTLE
Suffix:
Gender:M
Credentials:BCABA
Other - Prefix:
Other - First Name:CORNERSTONE
Other - Middle Name:BEHAVIORAL
Other - Last Name:THERAPY, LLC.
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 110446
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-0446
Mailing Address - Country:US
Mailing Address - Phone:203-727-3617
Mailing Address - Fax:
Practice Address - Street 1:23 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4607
Practice Address - Country:US
Practice Address - Phone:203-880-5041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-10
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0-11-4151103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst