Healthcare Provider Details

I. General information

NPI: 1376277806
Provider Name (Legal Business Name): TUTU A WREH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 04/07/2023
Certification Date: 04/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 E 45TH ST RM 9E
NEW YORK NY
10017-3337
US

IV. Provider business mailing address

228 E 45TH ST RM 9E
NEW YORK NY
10017-3337
US

V. Phone/Fax

Practice location:
  • Phone: 212-812-8054
  • Fax:
Mailing address:
  • Phone: 724-405-7049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCW022527
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number13269670-3501
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13269670-3501
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberCW022527
License Number StatePA
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW022527
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: