Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 088762 | NY |
Y | 101YM0800X | Mental Health Counselor | 44SC05895200 | NJ |
NPI | 1003198276 |
---|---|
Provider Name | Barry Wasser |
First Address | Jersey City, NJ 07306-2806 |
Second Address | Jersey City, NJ 07306-2806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2011 |
Last Update Date | 18/02/2020 |