Doctor Name: | MS. ROBERTA LYNN WASSERMAN |
NPI Number: | 1003151507 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW-C |
License Number: | 15010 |
Business Practice Address: | 2405 Forest Edge Ct Apt. 304d Odenton, MD - 211132830 |
Business Phone Number: | 4105701694 |
Business Fax Number: | |
Mailing Address: | 2405 Forest Edge Ct, #304d ODENTON |
State: | MD |
Postal Code: | 211132830 |
Phone Number: | 4105701694 |
Fax Number: | |
NPI Enumeration Date: | 12/10/2012 |
NPI Last Update Date: | 12/11/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 15010 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |