Provider Demographics
NPI:1215064035
Name:LUTZ, KATHLEEN (LCSW, LCADC, CP)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:LUTZ
Suffix:
Gender:F
Credentials:LCSW, LCADC, CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3582
Mailing Address - Country:US
Mailing Address - Phone:201-836-0303
Mailing Address - Fax:973-403-2927
Practice Address - Street 1:460 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3582
Practice Address - Country:US
Practice Address - Phone:201-836-0303
Practice Address - Fax:973-403-2927
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2011-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC003573001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical