Healthcare Provider Details

I. General information

NPI: 1902969660
Provider Name (Legal Business Name): LISA WASSERMAN PSY.D., ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 JOHNSON ST
HOLLYWOOD FL
33021-5421
US

IV. Provider business mailing address

14811 ARCHERHALL ST
DAVIE FL
33331-2955
US

V. Phone/Fax

Practice location:
  • Phone: 954-985-5809
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number96-180
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: