Provider Demographics
NPI:1962453886
Name:VASSER, RAYMOND J (PHD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:J
Last Name:VASSER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 HAYNES ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-6712
Mailing Address - Country:US
Mailing Address - Phone:248-646-2747
Mailing Address - Fax:248-288-4652
Practice Address - Street 1:999 HAYNES ST
Practice Address - Street 2:SUITE 250
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6712
Practice Address - Country:US
Practice Address - Phone:248-646-2747
Practice Address - Fax:248-288-4652
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007101103TC0700X
MI68010096271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI71020000F33180OtherBLUE CROSS PROVIDER NUMBE
MIOM83610Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER