Healthcare Provider Details

I. General information

NPI: 1265499446
Provider Name (Legal Business Name): MARCY WASMAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9150 SW 87TH AVE SUITE 109
MIAMI FL
33176-2319
US

IV. Provider business mailing address

9150 SW 87TH AVE SUITE 109
MIAMI FL
33176-2319
US

V. Phone/Fax

Practice location:
  • Phone: 305-274-5677
  • Fax: 305-596-6947
Mailing address:
  • Phone: 305-274-5677
  • Fax: 305-596-6947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY3375
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: