Provider Demographics
NPI:1649240490
Name:WASSERMAN, CHARLES B (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:B
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 1:103 S HIGH ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-3262
Mailing Address - Country:US
Mailing Address - Phone:610-429-4355
Mailing Address - Fax:610-429-4355
Practice Address - Street 1:103 S HIGH ST
Practice Address - Street 2:SUITE 7
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-3262
Practice Address - Country:US
Practice Address - Phone:610-429-4355
Practice Address - Fax:610-429-4355
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-005589-L103TC0700X
DEB1-0000528103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical