Healthcare Provider Details

I. General information

NPI: 1205292190
Provider Name (Legal Business Name): KAREN NANCY WASSERMAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2016
Last Update Date: 01/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 VISTA TER
LIVINGSTON NJ
07039-1915
US

IV. Provider business mailing address

12 VISTA TERRACE
LIVINGSTON NJ
07039
US

V. Phone/Fax

Practice location:
  • Phone: 917-696-5671
  • Fax:
Mailing address:
  • Phone: 917-696-5671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number4734
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: