Healthcare Provider Details

I. General information

NPI: 1982786372
Provider Name (Legal Business Name): LAURIE LUTOMSKI LBSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 S MANSFIELD ST
YPSILANTI MI
48197-5156
US

IV. Provider business mailing address

7555 WHITTAKER RD
YPSILANTI MI
48197-9772
US

V. Phone/Fax

Practice location:
  • Phone: 734-483-9363
  • Fax: 734-483-9557
Mailing address:
  • Phone: 734-483-9363
  • Fax: 734-483-9557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6802034385
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: