| Doctor Name: | STUART G ITZKOWITZ |
| NPI Number: | 1083891527 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | 6301006500 |
| Business Practice Address: | 74 W Long Lake Rd Suite 104 Bloomfield Hills, MI - 483042769 |
| Business Phone Number: | 2486426066 |
| Business Fax Number: | 2486425739 |
| Mailing Address: | 22626 Statler St, SAINT CLAIR SHORES |
| State: | MI |
| Postal Code: | 480812366 |
| Phone Number: | 5863622660 |
| Fax Number: | |
| NPI Enumeration Date: | 01/28/2008 |
| NPI Last Update Date: | 01/28/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TB0200X |
| License Number: | 6301006500 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Cognitive & Behavioral |
| Taxonomy Definition: | |