Provider Demographics
NPI:1366522773
Name:LUTZ, JOHN P (MCAT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:LUTZ
Suffix:
Gender:M
Credentials:MCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1238 CALLOWHILL ST
Mailing Address - Street 2:804
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-3613
Mailing Address - Country:US
Mailing Address - Phone:215-951-8127
Mailing Address - Fax:215-581-3827
Practice Address - Street 1:4200 MONUMENT RD
Practice Address - Street 2:BELMONT CENTER,
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-1625
Practice Address - Country:US
Practice Address - Phone:215-951-8127
Practice Address - Fax:215-581-3827
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000725101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional