Provider Demographics
NPI:1164432779
Name:WASSERMAN, SANDRA L (MFT, RPT)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:L
Last Name:WASSERMAN
Suffix:
Gender:F
Credentials:MFT, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 STARLIGHT GLN
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-3860
Mailing Address - Country:US
Mailing Address - Phone:760-744-3058
Mailing Address - Fax:
Practice Address - Street 1:2541 STATE ST
Practice Address - Street 2:SUITE 203
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1678
Practice Address - Country:US
Practice Address - Phone:760-271-9467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT41424106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist