| Doctor Name: | DR. JOHN CARL LUTZ |
| NPI Number: | 1699826172 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PSY.D. |
| License Number: | 7517 |
| Business Practice Address: | 148 Worcester St West Boylston, MA - 015831751 |
| Business Phone Number: | 5088351735 |
| Business Fax Number: | 5088351736 |
| Mailing Address: | 148 Worcester St, WEST BOYLSTON |
| State: | MA |
| Postal Code: | 015831751 |
| Phone Number: | 5088351735 |
| Fax Number: | 5088351736 |
| NPI Enumeration Date: | 01/13/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC2200X |
| License Number: | 7517 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical Child & Adolescent |
| Taxonomy Definition: | |