Provider Demographics
NPI:1457361644
Name:LITZ, BRETT (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:
Last Name:LITZ
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 1:46 CHESTNUT SQ
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2220
Mailing Address - Country:US
Mailing Address - Phone:617-524-3177
Mailing Address - Fax:
Practice Address - Street 1:46 CHESTNUT SQ
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2220
Practice Address - Country:US
Practice Address - Phone:617-524-3177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4742103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical