Provider Demographics
NPI:1245423730
Name:LUTZ, MICHELE ANN (LCSW)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:ANN
Last Name:LUTZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MICHELE
Other - Middle Name:ANN
Other - Last Name:LUTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:307 HIGHLAND TRL
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-4409
Mailing Address - Country:US
Mailing Address - Phone:352-391-1601
Mailing Address - Fax:
Practice Address - Street 1:307 HIGHLAND TRL
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-4409
Practice Address - Country:US
Practice Address - Phone:352-391-1601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 85881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical