Provider Demographics
NPI:1841781796
Name:WASSEL, PERLA LIA (LMSW)
Entity Type:Individual
Prefix:
First Name:PERLA
Middle Name:LIA
Last Name:WASSEL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 GLEN RD
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-1642
Mailing Address - Country:US
Mailing Address - Phone:516-297-9080
Mailing Address - Fax:270-818-7211
Practice Address - Street 1:4045 75TH ST FL 3
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1011
Practice Address - Country:US
Practice Address - Phone:718-505-1531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-27
Last Update Date:2018-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103605104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker