Provider Demographics
NPI:1912999806
Name:WASSERMAN, DAVID F (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:F
Last Name:WASSERMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4882 MCGRATH ST
Mailing Address - Street 2:STE. 210
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7722
Mailing Address - Country:US
Mailing Address - Phone:805-844-3869
Mailing Address - Fax:
Practice Address - Street 1:4882 MCGRATH ST
Practice Address - Street 2:STE. 210
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-7722
Practice Address - Country:US
Practice Address - Phone:805-339-0937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2017-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14388103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP14388Medicare ID - Type Unspecified