Dr. Jack Saul Wasserman
Clinical Psychologist Addiction Psychologist (Substance Use Disorder)
1101 Dove St
Newport Beach
, California 92660-2839
Dr. Jack Saul Wasserman
Clinical Psychologist Addiction Psychologist (Substance Use Disorder)
1101 Dove St
Newport Beach
, California 92660-2839
(714) 812-6869
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About
Features
Specialties
- Addiction Psychologist (Substance Use Disorder)
- Clinical Psychologist
Languages spoken
- English
Location
First Address
- Dr. Jack Saul Wasserman
- 1101 Dove St
- Newport Beach, CA
- Zip : 92660-2839
- Phone : (714) 812-6869
Second Address
- Dr. Jack Saul Wasserman
- 1101 Dove St
- Newport Beach, CA
- Zip : 92660-2839
- Phone : (714) 812-6869
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PSY11898 | CA |
| Y | 103G00000X | Clinical Psychologist | 11898 | CA |
| Y | 103TC0700X | Clinical Psychologist | 11898 | CA |
National Provider Identifier
| NPI | 1225134893 |
|---|---|
| Provider Name | Dr. Jack Saul Wasserman |
| First Address | Newport Beach, CA 92660-2839 |
| Second Address | Newport Beach, CA 92660-2839 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 14/09/2006 |
| Last Update Date | 22/01/2019 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 1225134893 | 103TA0400X (01) | CA |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.