Provider Demographics
NPI:1578816849
Name:WASSERMAN, ILANA S (MFT, LEP)
Entity type:Individual
Prefix:
First Name:ILANA
Middle Name:S
Last Name:WASSERMAN
Suffix:
Gender:F
Credentials:MFT, LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 W ORANGEWOOD AVE
Mailing Address - Street 2:STE. 101
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2004
Mailing Address - Country:US
Mailing Address - Phone:714-856-8333
Mailing Address - Fax:714-936-7720
Practice Address - Street 1:1745 W ORANGEWOOD AVE
Practice Address - Street 2:STE. 101
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2004
Practice Address - Country:US
Practice Address - Phone:714-856-8333
Practice Address - Fax:714-936-7720
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2783103TS0200X
CA40707106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool