Provider Demographics
NPI:1770616195
Name:WASSERMAN, GAIL A (PHD)
Entity type:Individual
Prefix:DR
First Name:GAIL
Middle Name:A
Last Name:WASSERMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HORNBEAM LN
Mailing Address - Street 2:
Mailing Address - City:KINNELON
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-2443
Mailing Address - Country:US
Mailing Address - Phone:212-543-5296
Mailing Address - Fax:212-543-1000
Practice Address - Street 1:2 HORNBEAM LN
Practice Address - Street 2:
Practice Address - City:KINNELON
Practice Address - State:NJ
Practice Address - Zip Code:07405-2443
Practice Address - Country:US
Practice Address - Phone:212-543-5296
Practice Address - Fax:212-543-1000
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006794-1103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent