Provider Demographics
NPI:1013926252
Name:WASSERMAN, FREDDA (MFT)
Entity Type:Individual
Prefix:
First Name:FREDDA
Middle Name:
Last Name:WASSERMAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9625 BOLTON RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-1041
Mailing Address - Country:US
Mailing Address - Phone:310-503-1632
Mailing Address - Fax:
Practice Address - Street 1:1950 SAWTELLE BLVD STE 355
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7072
Practice Address - Country:US
Practice Address - Phone:310-503-1632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 37428106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEIN 41-2084865OtherEMPLOYER TAX ID #