Provider Demographics
NPI:1235687377
Name:TUTTLE, ALICIA (MSW)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:
Last Name:TUTTLE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5790 FALCON BLVD
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32927-2315
Mailing Address - Country:US
Mailing Address - Phone:321-987-1197
Mailing Address - Fax:
Practice Address - Street 1:5790 FALCON BLVD
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32927-2315
Practice Address - Country:US
Practice Address - Phone:321-987-1197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical