Provider Demographics
NPI:1659470540
Name:WASSERMAN, DAVID ALLAN (PHD)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALLAN
Last Name:WASSERMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:257 CONNECTICUT ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-2402
Mailing Address - Country:US
Mailing Address - Phone:415-263-0980
Mailing Address - Fax:415-621-2357
Practice Address - Street 1:257 CONNECTICUT ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-2402
Practice Address - Country:US
Practice Address - Phone:415-263-0980
Practice Address - Fax:415-621-2357
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 11897103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PL118970Medicare PIN