Provider Demographics
NPI:1871876540
Name:KUTTNER, FREDERICK HARRIS (MA)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:HARRIS
Last Name:KUTTNER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 MILL POND DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-1413
Mailing Address - Country:US
Mailing Address - Phone:831-588-5335
Mailing Address - Fax:
Practice Address - Street 1:725 FRONT ST STE 200
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4538
Practice Address - Country:US
Practice Address - Phone:831-588-5335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11146101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional