Provider Demographics
NPI:1790325744
Name:ADAM WASSERMAN, NA'AMA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NA'AMA
Middle Name:
Last Name:ADAM WASSERMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 SAINT JOHNS AVE APT C
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2411
Mailing Address - Country:US
Mailing Address - Phone:224-619-2348
Mailing Address - Fax:
Practice Address - Street 1:4753 N BROADWAY ST STE 900
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-7908
Practice Address - Country:US
Practice Address - Phone:773-989-2780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.006175103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical