Provider Demographics
NPI:1477262947
Name:WASSERMAN, SERENA (LAC)
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:
Last Name:WASSERMAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 REGENCY CIR
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-5049
Mailing Address - Country:US
Mailing Address - Phone:201-562-5097
Mailing Address - Fax:
Practice Address - Street 1:105 GROVE ST STE 5A
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-4053
Practice Address - Country:US
Practice Address - Phone:973-619-9619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health