Provider Demographics
NPI:1447623871
Name:WASSERMAN, DANA BETH (PSYD)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:BETH
Last Name:WASSERMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:DANA
Other - Middle Name:BETH
Other - Last Name:SHUSTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:8050 N PALM AVE
Mailing Address - Street 2:SUITE 313
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-5510
Mailing Address - Country:US
Mailing Address - Phone:559-549-4615
Mailing Address - Fax:
Practice Address - Street 1:8050 N PALM AVE
Practice Address - Street 2:SUITE 313
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-5510
Practice Address - Country:US
Practice Address - Phone:559-549-4615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-06
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27567103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical