Basic Information
| Provider Information | |||||||||
| NPI: | 1881268803 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUTZ | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | |||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 525 MAIN ST STE E | ||||||||
| Address2: | |||||||||
| City: | SOUTH PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041065457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077670991 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 525 MAIN ST STE E | ||||||||
| Address2: | |||||||||
| City: | SOUTH PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041065457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077670991 | ||||||||
| FaxNumber: | 2077670995 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2021 | ||||||||
| LastUpdateDate: | 05/14/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | MC18921 | ME | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.