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General NPI Number Information
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NPI Number | 1881283067
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Entity Type | Individual
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Provider Name | MELISSA WASSERMAN PSYD
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Gender | Female
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Dates
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Enumeration Date | 01/13/2021
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Last Update Date | 06/22/2022
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Provider Practice Location Address
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Address Line | 16 E 41ST ST STE 5B
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City | NEW YORK
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State | NY
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Zip | 10017-6217
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Country | US
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Telephone | 240-350-1011
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Fax |
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Provider Business Mailing Address
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Address Line | 200 W 67TH ST APT 15G
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City | NEW YORK
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State | NY
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Zip | 10023-0101
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 025015
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License Number State | NY
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