Provider Demographics
NPI:1003820101
Name:SPITZ, REUBEN TAYLOR (PHD)
Entity Type:Individual
Prefix:
First Name:REUBEN
Middle Name:TAYLOR
Last Name:SPITZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:567 VAUXHALL STREET EXT
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-4330
Mailing Address - Country:US
Mailing Address - Phone:860-608-4170
Mailing Address - Fax:860-447-1815
Practice Address - Street 1:567 VAUXHALL STREET EXT
Practice Address - Street 2:SUITE 203
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-4330
Practice Address - Country:US
Practice Address - Phone:860-608-4170
Practice Address - Fax:860-447-1815
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2273103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical