Provider Demographics
NPI:1578654596
Name:WASMAN, MARVIN (PHD)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:
Last Name:WASMAN
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 1:23230 CHAGRIN BLVD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5446
Mailing Address - Country:US
Mailing Address - Phone:216-831-2900
Mailing Address - Fax:216-831-4306
Practice Address - Street 1:23230 CHAGRIN BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5446
Practice Address - Country:US
Practice Address - Phone:216-831-2900
Practice Address - Fax:216-831-4306
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1002103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000197157OtherANTHEM BC & BS
OHCP05013Medicare ID - Type Unspecified
OH000000197157OtherANTHEM BC & BS