MEDICARE: MR. DAVID ALLAN WASSERMAN PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSY 11897	CA

General Provider Information

NPI Number	:	1659470540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID ALLAN WASSERMAN PHD

Provider Business Mailing Address
First Line	:	257 CONNECTICUT ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94107-2402
Country	:	US
Telephone Number	:	415-263-0980
Fax Number	:	415-621-2357

Provider Business Practice Location Address
First Line	:	257 CONNECTICUT ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94107-2402
Country	:	US
Telephone Number	:	415-263-0980
Fax Number	:	415-621-2357

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	07/09/2007

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