Provider Demographics
NPI:1639422421
Name:REITZ, BARBARA LEE (LCSW)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:LEE
Last Name:REITZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:LEE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:2268 NE GINGER TER
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-6703
Mailing Address - Country:US
Mailing Address - Phone:772-486-3718
Mailing Address - Fax:
Practice Address - Street 1:2268 NE GINGER TER
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-6703
Practice Address - Country:US
Practice Address - Phone:772-486-3718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW109891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical