Basic Information
| Provider Information | |||||||||
| NPI: | 1770612657 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RITZEMA | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 ARSENAL AVE | ||||||||
| Address2: | STE 202 | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283055478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103233368 | ||||||||
| FaxNumber: | 9104867000 | ||||||||
| Practice Location | |||||||||
| Address1: | 114 HIGHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283055306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104840176 | ||||||||
| FaxNumber: | 9104845781 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2007 | ||||||||
| LastUpdateDate: | 01/30/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TH0100X | 791 | NC | Y | Behavioral Health & Social Service Providers | Psychologist | Health Service |
ID Information
| ID | Type | State | Issuer | Description | 04488 | 01 | NC | BCBS | OTHER | C7486 | 01 | NC | MEDCOST | OTHER | 6000313 | 05 | NC | MEDICAID |