Provider Demographics
NPI:1467853887
Name:LUTENBERG, ANA (LCSW)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:LUTENBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 RUMFORD AVE
Mailing Address - Street 2:CHILDREN'S CHARTER
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-3872
Mailing Address - Country:US
Mailing Address - Phone:781-894-4325
Mailing Address - Fax:781-894-1195
Practice Address - Street 1:77 RUMFORD AVE
Practice Address - Street 2:CHILDREN'S CHARTER
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-3872
Practice Address - Country:US
Practice Address - Phone:781-894-4325
Practice Address - Fax:781-894-1195
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-05
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0002253501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical