Provider Demographics
NPI:1538377403
Name:LUTUS, ROSEMARY ANN (MFT)
Entity type:Individual
Prefix:MS
First Name:ROSEMARY
Middle Name:ANN
Last Name:LUTUS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19925 STEVENS CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-2300
Mailing Address - Country:US
Mailing Address - Phone:408-450-8755
Mailing Address - Fax:408-377-4599
Practice Address - Street 1:19925 STEVENS CREEK BLVD
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2300
Practice Address - Country:US
Practice Address - Phone:408-450-8755
Practice Address - Fax:408-377-4599
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 24024106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist