Provider Demographics
NPI:1164585386
Name:REITMAN, MICHAEL N (LCSW, LADC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:N
Last Name:REITMAN
Suffix:
Gender:M
Credentials:LCSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-1240
Mailing Address - Country:US
Mailing Address - Phone:908-461-5311
Mailing Address - Fax:
Practice Address - Street 1:1088 BLACK ROCK TPKE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-4107
Practice Address - Country:US
Practice Address - Phone:908-461-5311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0063451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical