Healthcare Provider Details

I. General information

NPI: 1295752707
Provider Name (Legal Business Name): ROBERT PHILIP LASSER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 SIR FRANCIS DRAKE BLVD
KENTFIELD CA
94904-1418
US

IV. Provider business mailing address

1125 SIR FRANCIS DRAKE BLVD
KENTFIELD CA
94904-1418
US

V. Phone/Fax

Practice location:
  • Phone: 415-485-3629
  • Fax:
Mailing address:
  • Phone: 415-485-3629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberPSY7037
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: