Provider Demographics
NPI:1578896437
Name:LUTZ CHILD AND FAMILY ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:LUTZ CHILD AND FAMILY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHILD PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:BODMER
Authorized Official - Last Name:LUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:774-239-2013
Mailing Address - Street 1:47 PROSPECT ST
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:WEST BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01583-1301
Mailing Address - Country:US
Mailing Address - Phone:774-239-2013
Mailing Address - Fax:
Practice Address - Street 1:47 PROSPECT ST
Practice Address - Street 2:SUITE ONE
Practice Address - City:WEST BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01583-1301
Practice Address - Country:US
Practice Address - Phone:774-239-2013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUTZ CHILD AND FAMILY ASSOCIATES, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-10
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1568242084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1356460505OtherNPI