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General NPI Number Information
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NPI Number | 1477262947
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Entity Type | Individual
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Provider Name | SERENA WASSERMAN LAC
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Gender | Female
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Dates
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Enumeration Date | 11/23/2022
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Last Update Date | 11/23/2022
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Provider Practice Location Address
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Address Line | 105 GROVE ST STE 5A
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City | MONTCLAIR
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State | NJ
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Zip | 07042-4053
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Country | US
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Telephone | 973-619-9619
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Fax |
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Provider Business Mailing Address
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Address Line | 47 REGENCY CIR
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-5049
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Country | US
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Telephone | 201-562-5097
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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