Provider Demographics
NPI:1295079911
Name:STIRITZ, REBECCA (PSYD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:STIRITZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 HEIGHTS ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820
Mailing Address - Country:US
Mailing Address - Phone:203-921-6337
Mailing Address - Fax:
Practice Address - Street 1:40 HEIGHTS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-4132
Practice Address - Country:US
Practice Address - Phone:203-921-6337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002720103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical