Provider Demographics
NPI:1982786372
Name:LUTOMSKI, LAURIE (LBSW)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:LUTOMSKI
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7555 WHITTAKER RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-9772
Mailing Address - Country:US
Mailing Address - Phone:734-483-9363
Mailing Address - Fax:734-483-9557
Practice Address - Street 1:615 S MANSFIELD ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-5156
Practice Address - Country:US
Practice Address - Phone:734-483-9363
Practice Address - Fax:734-483-9557
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802034385104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker