Provider Demographics
NPI:1982075016
Name:LAUTZENHEISER, BRITTANY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:
Last Name:LAUTZENHEISER
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 1:4579 PINE RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-9124
Mailing Address - Country:US
Mailing Address - Phone:201-317-5753
Mailing Address - Fax:
Practice Address - Street 1:4579 PINE RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-9124
Practice Address - Country:US
Practice Address - Phone:201-317-5753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-15
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101YA0400X
NJ44SC060950001041C0700X
PACW0222421041C0700X
FL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0023701Medicaid