Provider Demographics
NPI:1043589575
Name:WASSERMAN, PAMELA B (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:B
Last Name:WASSERMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 EILEEN WAY
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-5325
Mailing Address - Country:US
Mailing Address - Phone:516-695-9814
Mailing Address - Fax:
Practice Address - Street 1:115 EILEEN WAY
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-5325
Practice Address - Country:US
Practice Address - Phone:516-695-9814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-29
Last Update Date:2013-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015296-1103TC0700X
IL071005405103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical