Provider Demographics
NPI:1851411631
Name:REISMAN, MARK (RAS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:REISMAN
Suffix:
Gender:M
Credentials:RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-1633
Mailing Address - Country:US
Mailing Address - Phone:707-253-4754
Mailing Address - Fax:707-259-8716
Practice Address - Street 1:2261 ELM ST
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-3721
Practice Address - Country:US
Practice Address - Phone:707-253-4754
Practice Address - Fax:707-259-8716
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR0509011608101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)