Provider Demographics
NPI:1386209476
Name:LUTZ, TRACEY (LMSW)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:
Last Name:LUTZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CENTER MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11934-2205
Mailing Address - Country:US
Mailing Address - Phone:631-404-7164
Mailing Address - Fax:
Practice Address - Street 1:12 OAK ST # 3
Practice Address - Street 2:
Practice Address - City:WESTHAMPTON BEACH
Practice Address - State:NY
Practice Address - Zip Code:11978-2020
Practice Address - Country:US
Practice Address - Phone:631-404-7164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-05
Last Update Date:2019-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055043104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker