Provider Demographics
NPI:1386875342
Name:RISER, RANDALL E (LMSW)
Entity type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:E
Last Name:RISER
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 1:221 N GORDON ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-1212
Mailing Address - Country:US
Mailing Address - Phone:269-781-9455
Mailing Address - Fax:269-781-9477
Practice Address - Street 1:221 N GORDON ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-1212
Practice Address - Country:US
Practice Address - Phone:269-781-9455
Practice Address - Fax:269-781-9477
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010591601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical