Provider Demographics
NPI:1649455957
Name:WASSERMAN, GANGA MAYEE JOYCE (LCSW)
Entity type:Individual
Prefix:MS
First Name:GANGA MAYEE
Middle Name:JOYCE
Last Name:WASSERMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JOYCE
Other - Middle Name:RAE
Other - Last Name:BIERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13537 US HIGHWAY 1
Mailing Address - Street 2:#137
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3760
Mailing Address - Country:US
Mailing Address - Phone:772-589-7008
Mailing Address - Fax:772-589-7008
Practice Address - Street 1:7766 BAY ST
Practice Address - Street 2:#11
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3427
Practice Address - Country:US
Practice Address - Phone:772-589-7008
Practice Address - Fax:772-589-7008
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-04
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW63481041C0700X
CALCS121811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ9500Medicare PIN