MEDICARE: DR. ERIC CHRISTOPHER REITZ PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY 9149	CA
2	103TC2200X	Clinical Child & Adolescent Psychologist	PSY 9149	CA
3	103TF0000X	Family Psychologist	PSY 9149	CA
4	103T00000X	Psychologist	PSY 9149	CA
5	106H00000X	Marriage & Family Therapist	M 13509	CA

General Provider Information

NPI Number	:	1710081252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC CHRISTOPHER REITZ PH.D.

Provider Business Mailing Address
First Line	:	21 DOMINICAN DR
Second Line	:
City	:	SAN RAFAEL
State	:	CA
Zip	:	94901-1337
Country	:	US
Telephone Number	:	415-459-5249
Fax Number	:	415-329-1613

Provider Business Practice Location Address
First Line	:	21 DOMINICAN DR
Second Line	:
City	:	SAN RAFAEL
State	:	CA
Zip	:	94901-1337
Country	:	US
Telephone Number	:	415-459-5249
Fax Number	:	415-329-1613

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	09/11/2025

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