Provider Demographics
NPI:1982753224
Name:LUTZ, JOANN CAROL (MSW)
Entity Type:Individual
Prefix:MS
First Name:JOANN
Middle Name:CAROL
Last Name:LUTZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 BLACK BIRCH TRL
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-3610
Mailing Address - Country:US
Mailing Address - Phone:413-586-6384
Mailing Address - Fax:413-586-6384
Practice Address - Street 1:13 OLD SOUTH ST
Practice Address - Street 2:2-E
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3840
Practice Address - Country:US
Practice Address - Phone:413-586-6384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1074671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1850067Medicaid
MAP06504OtherBLUE CROSSBLUE SHIELD
MAP06504Medicare ID - Type Unspecified