Provider Demographics
NPI:1881849503
Name:RAISSMAN, LAUREL NAN (MA,EDS)
Entity Type:Individual
Prefix:MS
First Name:LAUREL
Middle Name:NAN
Last Name:RAISSMAN
Suffix:
Gender:F
Credentials:MA,EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 CURREY LN
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2163
Mailing Address - Country:US
Mailing Address - Phone:973-736-1848
Mailing Address - Fax:
Practice Address - Street 1:27 CURREY LN
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2163
Practice Address - Country:US
Practice Address - Phone:973-736-1848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-21
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
NJ37FI00145500101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist