Provider Demographics
NPI:1962026120
Name:TUFO, OLIVIA LOUISE
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:LOUISE
Last Name:TUFO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 RAY HILL RD
Mailing Address - Street 2:
Mailing Address - City:EAST HADDAM
Mailing Address - State:CT
Mailing Address - Zip Code:06423-1353
Mailing Address - Country:US
Mailing Address - Phone:860-383-9342
Mailing Address - Fax:
Practice Address - Street 1:40 BROADWAY
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-5702
Practice Address - Country:US
Practice Address - Phone:860-887-6536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-03
Last Update Date:2021-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT110391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical