Provider Demographics
NPI:1134114937
Name:LUTZO, MARY DEPAOLIS (PHD, LMHC)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:DEPAOLIS
Last Name:LUTZO
Suffix:
Gender:F
Credentials:PHD, LMHC
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:D
Other - Last Name:LUTZO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP, CRNA
Mailing Address - Street 1:1621 ANCROFT CT
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-7201
Mailing Address - Country:US
Mailing Address - Phone:727-822-0946
Mailing Address - Fax:
Practice Address - Street 1:7628 MASSACHUSETTS AVE
Practice Address - Street 2:RICHEY LAKES PLAZA
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-3022
Practice Address - Country:US
Practice Address - Phone:727-848-5683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-18
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7808101YM0800X
FLARNP2814872367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL311743000Medicaid
FL201160353OtherTRICARE
FLG1814TMedicare PIN