Healthcare Provider Details

I. General information

NPI: 1770612657
Provider Name (Legal Business Name): ROBERT J. RITZEMA PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 01/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 HIGHLAND AVE
FAYETTEVILLE NC
28305-5306
US

IV. Provider business mailing address

901 ARSENAL AVE STE 202
FAYETTEVILLE NC
28305-5478
US

V. Phone/Fax

Practice location:
  • Phone: 910-484-0176
  • Fax: 910-484-5781
Mailing address:
  • Phone: 910-323-3368
  • Fax: 910-486-7000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number791
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: