Provider Demographics
NPI:1659636751
Name:LUTZKER, AMANDA BETH (MSED)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:BETH
Last Name:LUTZKER
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 E 69TH ST APT 4E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5561
Mailing Address - Country:US
Mailing Address - Phone:516-398-3628
Mailing Address - Fax:
Practice Address - Street 1:345 E 69TH ST APT 4E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5561
Practice Address - Country:US
Practice Address - Phone:516-398-3628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist