Provider Demographics
NPI:1134162415
Name:LUTZ, JAMES A (LCSW QCSW)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:LUTZ
Suffix:
Gender:M
Credentials:LCSW QCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 WELSH ROAD
Mailing Address - Street 2:STE 202
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006
Mailing Address - Country:US
Mailing Address - Phone:215-914-2119
Mailing Address - Fax:215-914-1663
Practice Address - Street 1:727 WELSH ROAD
Practice Address - Street 2:STE 202
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006
Practice Address - Country:US
Practice Address - Phone:215-914-2119
Practice Address - Fax:215-914-1663
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW014160101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA038749N5MMedicare ID - Type Unspecified
P08682Medicare UPIN