Healthcare Provider Details

I. General information

NPI: 1356460505
Provider Name (Legal Business Name): ANNE BODMER LUTZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 05/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 BELMONT ST
WORCESTER MA
01604-1675
US

IV. Provider business mailing address

275 BELMONT ST
WORCESTER MA
01604-1675
US

V. Phone/Fax

Practice location:
  • Phone: 508-791-3261
  • Fax:
Mailing address:
  • Phone: 508-791-3261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number156824
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: