Provider Demographics
NPI:1114045739
Name:WASSERMAN, LORI (PHD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:
Last Name:WASSERMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21301 POWERLINE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-2388
Mailing Address - Country:US
Mailing Address - Phone:561-451-8408
Mailing Address - Fax:561-451-8655
Practice Address - Street 1:21301 POWERLINE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-2388
Practice Address - Country:US
Practice Address - Phone:561-451-8408
Practice Address - Fax:561-451-8655
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY - 0003905103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical