Provider Demographics
NPI:1326246620
Name:REITZ, JANE MARIE (MFT)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:MARIE
Last Name:REITZ
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 21ST ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-2201
Mailing Address - Country:US
Mailing Address - Phone:310-545-4057
Mailing Address - Fax:
Practice Address - Street 1:2200 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2757
Practice Address - Country:US
Practice Address - Phone:310-545-4532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 27449106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFT 27449OtherMARRIAGE FAMILY THERAPIST