Provider Demographics
NPI:1699826172
Name:LUTZ, JOHN CARL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CARL
Last Name:LUTZ
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 WORCESTER ST
Mailing Address - Street 2:
Mailing Address - City:WEST BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01583-1751
Mailing Address - Country:US
Mailing Address - Phone:508-835-1735
Mailing Address - Fax:508-835-1736
Practice Address - Street 1:148 WORCESTER ST
Practice Address - Street 2:
Practice Address - City:WEST BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01583-1751
Practice Address - Country:US
Practice Address - Phone:508-835-1735
Practice Address - Fax:508-835-1736
Is Sole Proprietor?:No
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7517103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent