Provider Demographics
NPI:1346507043
Name:WASMANSKI, AVERY ROSE (MED, LPC)
Entity Type:Individual
Prefix:MS
First Name:AVERY
Middle Name:ROSE
Last Name:WASMANSKI
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:AVERY
Other - Middle Name:ROSE
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:25 W CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:ROYERSFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19468-1301
Mailing Address - Country:US
Mailing Address - Phone:484-995-1190
Mailing Address - Fax:
Practice Address - Street 1:1610 MEDICAL DR STE 310
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464
Practice Address - Country:US
Practice Address - Phone:610-970-5000
Practice Address - Fax:610-970-3331
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009623101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health