Provider Demographics
NPI:1720526742
Name:MIZER, RAYMOND (MA)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:
Last Name:MIZER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 REDONDO LN
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-2953
Mailing Address - Country:US
Mailing Address - Phone:719-744-7444
Mailing Address - Fax:
Practice Address - Street 1:4 REDONDO LN
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-2953
Practice Address - Country:US
Practice Address - Phone:719-744-7444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor