Healthcare Provider Details

I. General information

NPI: 1982431706
Provider Name (Legal Business Name): EVAN SAMUEL HENRITZE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

442 MAIN ST
GREENFIELD MA
01301-3335
US

IV. Provider business mailing address

PO BOX 75
GREENFIELD MA
01302-0075
US

V. Phone/Fax

Practice location:
  • Phone: 212-489-0246
  • Fax:
Mailing address:
  • Phone: 212-489-0246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY10001946
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number027511
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number048.0135374
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: