Provider Demographics
NPI:1265499446
Name:WASMAN, MARCY (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARCY
Middle Name:
Last Name:WASMAN
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 1:9150 SW 87TH AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2319
Mailing Address - Country:US
Mailing Address - Phone:305-274-5677
Mailing Address - Fax:305-596-6947
Practice Address - Street 1:9150 SW 87TH AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2319
Practice Address - Country:US
Practice Address - Phone:305-274-5677
Practice Address - Fax:305-596-6947
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3375103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75409Medicare ID - Type Unspecified