Provider Demographics
NPI:1407733348
Name:HAISSMAN, JAI (CR, SEP)
Entity type:Individual
Prefix:
First Name:JAI
Middle Name:
Last Name:HAISSMAN
Suffix:
Gender:M
Credentials:CR, SEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 FILBERT AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-1860
Mailing Address - Country:US
Mailing Address - Phone:415-828-8725
Mailing Address - Fax:
Practice Address - Street 1:142 FILBERT AVE APT 2
Practice Address - Street 2:
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-1860
Practice Address - Country:US
Practice Address - Phone:415-828-8725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist