Provider Demographics
NPI:1215485594
Name:MUTTILLO, AARON (PHD)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:MUTTILLO
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7271 ENGLE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-8404
Mailing Address - Country:US
Mailing Address - Phone:216-832-8368
Mailing Address - Fax:
Practice Address - Street 1:7271 ENGLE RD STE 101
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-8404
Practice Address - Country:US
Practice Address - Phone:216-832-8368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP578103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool