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General NPI Number Information
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NPI Number | 1902084775
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Entity Type | Organization
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Legal Business Name | DANIEL B WASSERMAN PHD PC
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Dates
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Enumeration Date | 02/04/2008
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Last Update Date | 02/04/2008
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Provider Practice Location Address
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Address Line | 339 S CORTEZ ST
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City | PRESCOTT
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State | AZ
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Zip | 86303-4315
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Country | US
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Telephone | 928-778-6259
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Fax |
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Provider Business Mailing Address
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Address Line | 339 S CORTEZ ST
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City | PRESCOTT
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State | AZ
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Zip | 86303-4315
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Country | US
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Telephone | 928-778-6259
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & PSYCHOLOGIST
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Name | DR. DANIEL B WASSERMAN
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Credential | PHD
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Telephone | 928-778-6259
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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 | 1170
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License Number State | AZ
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