Healthcare Provider Details

I. General information

NPI: 1245044965
Provider Name (Legal Business Name): VICTOR J WASSERMAN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 WHEELING ST
AURORA CO
80045-7211
US

IV. Provider business mailing address

311 MINER RD
HIGHLAND HEIGHTS OH
44143-1536
US

V. Phone/Fax

Practice location:
  • Phone: 713-305-9435
  • Fax:
Mailing address:
  • Phone: 713-305-9435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: