Provider Demographics
NPI:1043182843
Name:WASSERMAN, CONNIE (LCSW)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:WASSERMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CONSIGLIA
Other - Middle Name:
Other - Last Name:WASSERMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:232 E SHORE RD
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-5910
Mailing Address - Country:US
Mailing Address - Phone:631-697-8356
Mailing Address - Fax:
Practice Address - Street 1:64 DIVISION AVE
Practice Address - Street 2:SUITE 215C
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-2947
Practice Address - Country:US
Practice Address - Phone:631-697-8356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR057124-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical