Healthcare Provider Details

I. General information

NPI: 1063376903
Provider Name (Legal Business Name): HARLIE LUTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 BEAVERSON BLVD STE 8A
BRICK NJ
08723-7861
US

IV. Provider business mailing address

3135 QUARRY RD
MANCHESTER NJ
08759-5420
US

V. Phone/Fax

Practice location:
  • Phone: 908-373-1059
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL07126300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: