Provider Demographics
NPI:1730571217
Name:LUTZ, KRYSTLE JOY (LCSW)
Entity type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:JOY
Last Name:LUTZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 NARRAGANSETT PKWY
Mailing Address - Street 2:SB 11
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-4546
Mailing Address - Country:US
Mailing Address - Phone:401-714-8360
Mailing Address - Fax:
Practice Address - Street 1:400 NARRAGANSETT PKWY
Practice Address - Street 2:SB 11
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-4546
Practice Address - Country:US
Practice Address - Phone:401-714-8360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-20
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW017771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical