Provider Demographics
NPI:1790881464
Name:WASSERMAN, DENISE J (MSW)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:J
Last Name:WASSERMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 KORITE
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-3531
Mailing Address - Country:US
Mailing Address - Phone:949-709-7081
Mailing Address - Fax:
Practice Address - Street 1:405 W 5TH ST
Practice Address - Street 2:STE. 212
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-4519
Practice Address - Country:US
Practice Address - Phone:714-834-2125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional