Provider Demographics
NPI:1316087695
Name:LUTZ, JENNIFER L (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:L
Last Name:LUTZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3117 POPLARWOOD CT
Mailing Address - Street 2:302
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-1009
Mailing Address - Country:US
Mailing Address - Phone:919-884-6266
Mailing Address - Fax:
Practice Address - Street 1:3117 POPLARWOOD CT
Practice Address - Street 2:302
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1009
Practice Address - Country:US
Practice Address - Phone:919-884-6266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053186001041C0700X
NCC0076521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical