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General NPI Number Information
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NPI Number | 1386209476
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Entity Type | Individual
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Provider Name | TRACEY LUTZ LMSW
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Gender | Female
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Dates
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Enumeration Date | 05/05/2019
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Last Update Date | 05/05/2019
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Provider Practice Location Address
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Address Line | 12 OAK ST # 3
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City | WESTHAMPTON BEACH
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State | NY
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Zip | 11978-2020
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Country | US
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Telephone | 631-404-7164
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Fax |
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Provider Business Mailing Address
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Address Line | 723 MAIN ST
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City | CENTER MORICHES
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State | NY
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Zip | 11934-2205
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Country | US
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Telephone | 631-404-7164
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 055043
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License Number State | NY
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