Provider Demographics
NPI:1902317134
Name:LUTES, DAVID (MSW,CA LCSW, OH LISW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LUTES
Suffix:
Gender:M
Credentials:MSW,CA LCSW, OH LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4470 W SUNSET BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6309
Mailing Address - Country:US
Mailing Address - Phone:302-858-0590
Mailing Address - Fax:
Practice Address - Street 1:4470 W SUNSET BLVD STE 107
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6309
Practice Address - Country:US
Practice Address - Phone:302-858-0590
Practice Address - Fax:833-419-0181
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-16
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.20024141041C0700X
CA1017431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical