Healthcare Provider Details

I. General information

NPI: 1710081252
Provider Name (Legal Business Name): ERIC CHRISTOPHER REITZ PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 DOMINICAN DR
SAN RAFAEL CA
94901-1337
US

IV. Provider business mailing address

21 DOMINICAN DR
SAN RAFAEL CA
94901-1337
US

V. Phone/Fax

Practice location:
  • Phone: 415-459-5249
  • Fax: 415-329-1613
Mailing address:
  • Phone: 415-459-5249
  • Fax: 415-329-1613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 9149
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY 9149
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPSY 9149
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 9149
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberM 13509
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: