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General NPI Number Information
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NPI Number | 1467045849
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Entity Type | Individual
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Provider Name | WENDY WASSERSTROM LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/16/2021
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Last Update Date | 02/16/2021
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Provider Practice Location Address
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Address Line | 2025 E MAIN ST STE 216
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City | RICHMOND
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State | VA
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Zip | 23223-7073
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Country | US
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Telephone | 804-644-0774
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Fax |
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Provider Business Mailing Address
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Address Line | 116 S DAVIS AVE APT 5105
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City | RICHMOND
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State | VA
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Zip | 23220-5159
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904012682
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License Number State | VA
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