Active NPI
Gwendolyne Elissa Tuttle, LMSW-CC
- Clinical Social Worker
- Portland, ME
National Provider Identifier
1811358054
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- MC15813
- Practice address
- 66 State St
Portland, ME 04101-3751 - Phone
- (207) 871-7431
- Fax
- (207) 871-7457
- NPI assigned
- Mar 16, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | MC15813 | ME | Primary |
Addresses
Primary practice location
66 State St
Portland, ME 04101-3751
Mailing address
PO Box 797
Portland, ME 04104-0797
Phone (207) 871-7431
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jun 21, 2024 through Jun 21, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MC15813 | ME | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1458086400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458086400000",
"number": "1811358054",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 797",
"city": "PORTLAND",
"state": "ME",
"postal_code": "041040797",
"telephone_number": "207-871-7431",
"fax_number": "207-871-7457"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "66 STATE ST",
"city": "PORTLAND",
"state": "ME",
"postal_code": "041013751",
"telephone_number": "207-871-7431",
"fax_number": "207-871-7457"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TUTTLE",
"first_name": "GWENDOLYNE",
"middle_name": "ELISSA",
"name_prefix": "Ms.",
"credential": "LMSW-CC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-03-16",
"last_updated": "2016-03-16",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "ME",
"license": "MC15813",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.