Provider Demographics
NPI:1194970400
Name:WASSERMAN, LEAH ROBIN (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:ROBIN
Last Name:WASSERMAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 STRATFORD RD
Mailing Address - Street 2:4B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-4361
Mailing Address - Country:US
Mailing Address - Phone:302-354-3683
Mailing Address - Fax:
Practice Address - Street 1:355 STRATFORD RD
Practice Address - Street 2:4B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-4361
Practice Address - Country:US
Practice Address - Phone:302-354-3683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018465235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist