Provider Demographics
NPI:1407057268
Name:RITTER, JACKIE (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:
Last Name:RITTER
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 1/2 DRY HILL RD
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-4027
Mailing Address - Country:US
Mailing Address - Phone:203-845-8771
Mailing Address - Fax:203-845-8771
Practice Address - Street 1:22 1 2 DRY HILL RD
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-4027
Practice Address - Country:US
Practice Address - Phone:203-845-8771
Practice Address - Fax:203-845-8771
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0018641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical