Provider Demographics
NPI:1588898233
Name:DAITZMAN, REID JOSEPH (PHD)
Entity type:Individual
Prefix:DR
First Name:REID
Middle Name:JOSEPH
Last Name:DAITZMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1177 HIGH RIDGE RD
Mailing Address - Street 2:209
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-1221
Mailing Address - Country:US
Mailing Address - Phone:203-322-1779
Mailing Address - Fax:203-968-0490
Practice Address - Street 1:1177 HIGH RIDGE RD
Practice Address - Street 2:209
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-1221
Practice Address - Country:US
Practice Address - Phone:203-322-1779
Practice Address - Fax:203-968-0490
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT682103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral