Provider Demographics
NPI:1255822839
Name:RICHMOND AND LUTTER
Entity type:Organization
Organization Name:RICHMOND AND LUTTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TIIU
Authorized Official - Middle Name:
Authorized Official - Last Name:LUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-437-2991
Mailing Address - Street 1:312 MORTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIDLEY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19078-3006
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:312 MORTON AVE
Practice Address - Street 2:
Practice Address - City:RIDLEY PARK
Practice Address - State:PA
Practice Address - Zip Code:19078-3006
Practice Address - Country:US
Practice Address - Phone:484-437-2991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-19
Last Update Date:2018-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000790106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty