Provider Demographics
NPI:1174688899
Name:KIRITZ, STEWART (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEWART
Middle Name:
Last Name:KIRITZ
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 1:84 KEENE ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-1508
Mailing Address - Country:US
Mailing Address - Phone:650-387-6120
Mailing Address - Fax:
Practice Address - Street 1:84 KEENE ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-1508
Practice Address - Country:US
Practice Address - Phone:650-387-6120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 4308103T00000X
RIPS01560103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist