Healthcare Provider Details

I. General information

NPI: 1093364465
Provider Name (Legal Business Name): KAREN DENISE LUTZ ACSW, RADT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 09/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2975 TREAT BLVD STE B5
CONCORD CA
94518-3687
US

IV. Provider business mailing address

1135 COTTAGE LN
HERCULES CA
94547-2703
US

V. Phone/Fax

Practice location:
  • Phone: 925-691-5083
  • Fax:
Mailing address:
  • Phone: 619-301-6788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW82933
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1359900819
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: