Provider Demographics
NPI:1134242290
Name:WASSERMAN, BARRY JAY
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:JAY
Last Name:WASSERMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 PLACERVILLE DR
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-3920
Mailing Address - Country:US
Mailing Address - Phone:530-409-2954
Mailing Address - Fax:
Practice Address - Street 1:344 PLACERVILLE DR STE 17
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-3972
Practice Address - Country:US
Practice Address - Phone:530-621-6220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health