Provider Demographics
NPI:1730120106
Name:WASSERMAN, MARDY I (EDD)
Entity Type:Individual
Prefix:DR
First Name:MARDY
Middle Name:I
Last Name:WASSERMAN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:959 E WALNUT ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-1451
Mailing Address - Country:US
Mailing Address - Phone:626-796-7760
Mailing Address - Fax:818-790-2468
Practice Address - Street 1:959 E WALNUT ST
Practice Address - Street 2:SUITE 212
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1451
Practice Address - Country:US
Practice Address - Phone:626-796-7760
Practice Address - Fax:818-790-2468
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY4984103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical