Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 2273 | CT |
Y | 103TC0700X | Clinical Psychologist | 2273 | CT |
NPI | 1003820101 |
---|---|
Provider Name | Reuben Taylor Spitz |
First Address | Waterford, CT 06385-4330 |
Second Address | Waterford, CT 06385-4330 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 08/07/2007 |