Active NPI
Joshua Anthony Lutz, ED,S, NCSP
- School Psychologist
- Gulf Breeze, FL
National Provider Identifier
1114158227
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- SS795
- Practice address
- 91 Bay Bridge Dr
Suite D
Gulf Breeze, FL 32561-4468 - Phone
- (866) 960-8806
- Fax
- (866) 960-8806
- NPI assigned
- Aug 6, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | SS795 | FL | Primary |
Addresses
Primary practice location
91 Bay Bridge Dr
Suite D
Gulf Breeze, FL 32561-4468
Mailing address
91 Bay Bridge Dr
Suite D
Gulf Breeze, FL 32561-4468
Phone (866) 960-8806
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11997743 | Other | FL | CAQH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SS795 | FL | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1249516800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1259798400000",
"number": "1114158227",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "91 BAY BRIDGE DR",
"address_2": "SUITE D",
"city": "GULF BREEZE",
"state": "FL",
"postal_code": "325614468",
"telephone_number": "866-960-8806",
"fax_number": "866-960-8806"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "91 BAY BRIDGE DR",
"address_2": "SUITE D",
"city": "GULF BREEZE",
"state": "FL",
"postal_code": "325614468",
"telephone_number": "866-960-8806",
"fax_number": "866-960-8806"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUTZ",
"first_name": "JOSHUA",
"middle_name": "ANTHONY",
"name_prefix": "Mr.",
"credential": "ED,S, NCSP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-08-06",
"last_updated": "2009-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "FL",
"license": "SS795",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "11997743",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gulf Breeze, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.