MEDICARE: DR. ROBERT W. LUTZ PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY 9383	CA

General Provider Information

NPI Number	:	1962519884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT W. LUTZ PH.D.

Provider Business Mailing Address
First Line	:	40 POWER LN
Second Line	:
City	:	FAIRFAX
State	:	CA
Zip	:	94930-1831
Country	:	US
Telephone Number	:	415-454-1710
Fax Number	:	415-454-1250

Provider Business Practice Location Address
First Line	:	946 IRVING ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-2207
Country	:	US
Telephone Number	:	415-454-1710
Fax Number	:	415-454-1250

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	07/08/2007

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