Provider Demographics
NPI:1912045550
Name:BIERSBACH, RAYMOND M (PHD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:M
Last Name:BIERSBACH
Suffix:
Gender:M
Credentials:PHD
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Other - Credentials:
Mailing Address - Street 1:7907 212TH ST SW
Mailing Address - Street 2:SUITE 9A
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7541
Mailing Address - Country:US
Mailing Address - Phone:425-582-7801
Mailing Address - Fax:425-361-7546
Practice Address - Street 1:7907 212TH ST SW
Practice Address - Street 2:SUITE 9A
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7541
Practice Address - Country:US
Practice Address - Phone:425-582-7801
Practice Address - Fax:425-361-7546
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJBI727683Medicare ID - Type Unspecified