Provider Demographics
NPI:1437296159
Name:WASSERMAN, THEODORE (PHD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:
Last Name:WASSERMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5325 GREENWOOD AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2452
Mailing Address - Country:US
Mailing Address - Phone:561-881-2822
Mailing Address - Fax:561-881-0972
Practice Address - Street 1:5325 GREENWOOD AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2452
Practice Address - Country:US
Practice Address - Phone:561-881-2822
Practice Address - Fax:561-881-0972
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3977103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent