Provider Demographics
NPI:1124168984
Name:WASSERMANN, CARSON ASHBY (MSW, LSW)
Entity type:Individual
Prefix:MS
First Name:CARSON
Middle Name:ASHBY
Last Name:WASSERMANN
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 VICTORY PKWY
Mailing Address - Street 2:STE. 500
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-2839
Mailing Address - Country:US
Mailing Address - Phone:513-221-2330
Mailing Address - Fax:513-221-8954
Practice Address - Street 1:2330 VICTORY PKWY
Practice Address - Street 2:STE. 500
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-2839
Practice Address - Country:US
Practice Address - Phone:513-221-2330
Practice Address - Fax:513-221-8954
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS0500668101YM0800X
OHI07003911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0057455Medicaid
OH0057455Medicaid