Provider Demographics
NPI:1790110203
Name:GWIRTZMAN, SARINA WASSERMAN (MA-CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SARINA
Middle Name:WASSERMAN
Last Name:GWIRTZMAN
Suffix:
Gender:F
Credentials:MA-CCC-SLP
Other - Prefix:MS
Other - First Name:SARINA
Other - Middle Name:W BERGER
Other - Last Name:WASSERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELDS
Mailing Address - State:NY
Mailing Address - Zip Code:10975-0309
Mailing Address - Country:US
Mailing Address - Phone:914-715-9180
Mailing Address - Fax:
Practice Address - Street 1:39 STERLING PINES RD
Practice Address - Street 2:
Practice Address - City:TUXEDO PARK
Practice Address - State:NY
Practice Address - Zip Code:10987-5016
Practice Address - Country:US
Practice Address - Phone:845-351-4335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000626-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist