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General NPI Number Information
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NPI Number | 1164585386
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Entity Type | Individual
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Provider Name | MICHAEL N. REITMAN LCSW, LADC
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Gender | Male
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1088 BLACK ROCK TPKE
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City | FAIRFIELD
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State | CT
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Zip | 06825-4107
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Country | US
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Telephone | 908-461-5311
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Fax |
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Provider Business Mailing Address
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Address Line | 245 VALLEY RD
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City | FAIRFIELD
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State | CT
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Zip | 06825-1240
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Country | US
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Telephone | 908-461-5311
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 006345
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License Number State | CT
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