Healthcare Provider Details

I. General information

NPI: 1285985812
Provider Name (Legal Business Name): BERENA DYAN WASSERSTEIN ATR-BC, LCAT, ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BERENA DYAN SULLIVAN ATR-BC, LCAT, ACSW

II. Dates (important events)

Enumeration Date: 09/22/2012
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 N 12TH ST FL 7
BROOKLYN NY
11249-1008
US

IV. Provider business mailing address

PO BOX 47
LA JOLLA CA
92038-0047
US

V. Phone/Fax

Practice location:
  • Phone: 646-883-6454
  • Fax:
Mailing address:
  • Phone: 646-883-6454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number129132
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number001240
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: