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General NPI Number Information
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NPI Number | 1578896437
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Entity Type | Organization
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Legal Business Name | LUTZ CHILD AND FAMILY ASSOCIATES, P.C.
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Dates
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Enumeration Date | 09/10/2009
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Last Update Date | 05/19/2011
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Provider Practice Location Address
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Address Line | 47 PROSPECT ST SUITE ONE
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City | WEST BOYLSTON
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State | MA
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Zip | 01583-1301
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Country | US
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Telephone | 774-239-2013
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Fax |
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Provider Business Mailing Address
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Address Line | 47 PROSPECT ST SUITE ONE
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City | WEST BOYLSTON
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State | MA
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Zip | 01583-1301
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Country | US
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Telephone | 774-239-2013
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Fax |
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Authorized Official
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Title or Position | CHILD PSYCHIATRIST
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Name | DR. ANNE BODMER LUTZ
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Credential | M.D.
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Telephone | 774-239-2013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 156824
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License Number State | MA
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