Provider Demographics
NPI:1336244284
Name:LUTSCH, MARIE (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:
Last Name:LUTSCH
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 N QUANTICO ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-1754
Mailing Address - Country:US
Mailing Address - Phone:703-534-5720
Mailing Address - Fax:
Practice Address - Street 1:6073 ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-2721
Practice Address - Country:US
Practice Address - Phone:703-550-4161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040037491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA491406Medicare ID - Type UnspecifiedPROVIDER NUMBER