Provider Demographics
NPI:1457621997
Name:WASSERMAN, SINDI DIANE (MFT)
Entity Type:Individual
Prefix:MS
First Name:SINDI
Middle Name:DIANE
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:P O BOX 1282
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91708
Mailing Address - Country:US
Mailing Address - Phone:909-680-1347
Mailing Address - Fax:
Practice Address - Street 1:876 N MOUNTAIN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4166
Practice Address - Country:US
Practice Address - Phone:909-931-3388
Practice Address - Fax:909-931-7311
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27586106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist