Provider Demographics
NPI:1346305018
Name:REITZ, WILLARD E (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLARD
Middle Name:E
Last Name:REITZ
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 1:3909 WASHINGTON RD
Mailing Address - Street 2:SUITE 318
Mailing Address - City:MCMURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2544
Mailing Address - Country:US
Mailing Address - Phone:724-941-4545
Mailing Address - Fax:724-941-7525
Practice Address - Street 1:3909 WASHINGTON RD
Practice Address - Street 2:SUITE 318
Practice Address - City:MCMURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2544
Practice Address - Country:US
Practice Address - Phone:724-941-4545
Practice Address - Fax:724-941-7525
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002143L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA286559OtherVALUEOPTIONS
PA286559OtherVALUEOPTIONS