| Doctor Name: | MR. BRADLEY MARK WASSERMAN |
| NPI Number: | 1225101074 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSW-C |
| License Number: | 08997 |
| Business Practice Address: | 18900 Bluewillow Ln Montgomery Village, MD - 208863137 |
| Business Phone Number: | 3013252103 |
| Business Fax Number: | 3017409001 |
| Mailing Address: | 18900 Bluewillow Ln, MONTGOMERY VILLAGE |
| State: | MD |
| Postal Code: | 208863137 |
| Phone Number: | 3013252103 |
| Fax Number: | 3017409001 |
| NPI Enumeration Date: | 11/17/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 08997 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |