Provider Demographics
NPI:1356401962
Name:BIZER, RANDALL A (LMSW)
Entity type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:A
Last Name:BIZER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 N CENTER ST STE 204
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1495
Mailing Address - Country:US
Mailing Address - Phone:248-895-8888
Mailing Address - Fax:
Practice Address - Street 1:108 N CENTER ST STE 204
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-1495
Practice Address - Country:US
Practice Address - Phone:248-895-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010597751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM85330Medicare ID - Type Unspecified
MIP208927230Medicare UPIN