Provider Demographics
NPI:1548519226
Name:TUTTLE, LISSETTE MALDONADO (MSW)
Entity type:Individual
Prefix:MRS
First Name:LISSETTE
Middle Name:MALDONADO
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 1:1617 SW CAMEO BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-1265
Mailing Address - Country:US
Mailing Address - Phone:772-240-2044
Mailing Address - Fax:
Practice Address - Street 1:2920 S 25TH ST
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34981-5605
Practice Address - Country:US
Practice Address - Phone:772-240-2044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical