Provider Demographics
NPI:1487130720
Name:LUTAT, SARA JANE (MSW, MLADC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:JANE
Last Name:LUTAT
Suffix:
Gender:F
Credentials:MSW, MLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 W CLARKE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-2448
Mailing Address - Country:US
Mailing Address - Phone:603-562-5351
Mailing Address - Fax:
Practice Address - Street 1:102 4TH ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-4540
Practice Address - Country:US
Practice Address - Phone:603-782-3004
Practice Address - Fax:603-518-8977
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1000101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)