Healthcare Provider Details

I. General information

NPI: 1013926252
Provider Name (Legal Business Name): FREDDA WASSERMAN MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 SAWTELLE BLVD STE 355
LOS ANGELES CA
90025-7072
US

IV. Provider business mailing address

9625 BOLTON RD
LOS ANGELES CA
90034-1041
US

V. Phone/Fax

Practice location:
  • Phone: 310-503-1632
  • Fax:
Mailing address:
  • Phone: 310-503-1632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 37428
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: