=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912137324
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CATHERINE ELAINE TUTTLE LICSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2009
-----------------------------------------------------
Last Update Date | 09/14/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 623 ATWELLS AVENUE SUITE 201
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-629-6668
-----------------------------------------------------
Fax | 617-625-6339
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 623 ATWELLS AVENUE SUITE 201
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-273-7103
-----------------------------------------------------
Fax | 401-421-4608
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 15W02167
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------