Basic Information
| Provider Information | |||||||||
| NPI: | 1154954261 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROBERT FASMAN PHD PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 717 NE 61ST ST STE 202 | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986658756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604500140 | ||||||||
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| Practice Location | |||||||||
| Address1: | 717 NE 61ST ST STE 202 | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986658756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604500140 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2020 | ||||||||
| LastUpdateDate: | 02/17/2020 | ||||||||
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| AuthorizedOfficialLastName: | FASMAN | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3604500140 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
| NPICertificationDate: | 02/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.