Provider Demographics
NPI:1205520699
Name:LUTZ, EMILY CAITLIN (LLMSW, SSW)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:CAITLIN
Last Name:LUTZ
Suffix:
Gender:F
Credentials:LLMSW, SSW
Other - Prefix:MISS
Other - First Name:EMILY
Other - Middle Name:CAITLIN
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW, SSW
Mailing Address - Street 1:19236 HAZELTON DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-6236
Mailing Address - Country:US
Mailing Address - Phone:810-834-1407
Mailing Address - Fax:
Practice Address - Street 1:2450 OLD SALEM RD
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-3432
Practice Address - Country:US
Practice Address - Phone:810-834-1407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511080811041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool