=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679808893
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CINDY L. TUTTLE, LCSW, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2009
-----------------------------------------------------
Last Update Date | 10/06/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 WAKEFIELD ST
-----------------------------------------------------
City | LEWISTON
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04240-6294
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-782-2332
-----------------------------------------------------
Fax | 207-786-7761
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 WAKEFIELD ST
-----------------------------------------------------
City | LEWISTON
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04240-6294
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-782-2332
-----------------------------------------------------
Fax | 207-786-7761
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. CINDY LESSARD TUTTLE
-----------------------------------------------------
Credential | L.C.S.W.
-----------------------------------------------------
Telephone | 207-782-2332
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LC6494
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------