Provider Demographics
NPI:1750584892
Name:LUTZ, EILEEN C (RN,LCSW,LCADC)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:C
Last Name:LUTZ
Suffix:
Gender:F
Credentials:RN,LCSW,LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 QUILL PEN WAY
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5518
Mailing Address - Country:US
Mailing Address - Phone:908-647-0479
Mailing Address - Fax:908-647-2592
Practice Address - Street 1:65 MOUNTAIN BLVD EXT
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-2632
Practice Address - Country:US
Practice Address - Phone:732-356-5665
Practice Address - Fax:732-356-0507
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC001729001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJNR32823OtherREGISTERED NURSE
NJ44SC00172900OtherLIC. CLINIC. SOC. WORKER
NJ44SC00172900OtherLIC. CLINIC. SOC. WORKER