Provider Demographics
NPI:1710081252
Name:REITZ, ERIC CHRISTOPHER (PHD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:CHRISTOPHER
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 1:21 DOMINICAN DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-1337
Mailing Address - Country:US
Mailing Address - Phone:415-459-5249
Mailing Address - Fax:415-329-1613
Practice Address - Street 1:21 DOMINICAN DR
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-1337
Practice Address - Country:US
Practice Address - Phone:415-459-5249
Practice Address - Fax:415-329-1613
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 9149103TC0700X, 103TC2200X, 103TF0000X, 103T00000X
CAM 13509106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL91491Medicare PIN