Provider Demographics
NPI:1396425500
Name:LUTZ, SARA JANE (LMSW)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:JANE
Last Name:LUTZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 E 12TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-4086
Mailing Address - Country:US
Mailing Address - Phone:516-639-8896
Mailing Address - Fax:
Practice Address - Street 1:421 E 12TH ST APT 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-4086
Practice Address - Country:US
Practice Address - Phone:516-639-8896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120306104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker