Provider Demographics
NPI:1215140520
Name:WASSERBERGER, LINDA SALLIE (MSW)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:SALLIE
Last Name:WASSERBERGER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1443
Mailing Address - Country:US
Mailing Address - Phone:516-835-7567
Mailing Address - Fax:
Practice Address - Street 1:80 LONG ISLAND EXPY
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-4105
Practice Address - Country:US
Practice Address - Phone:516-484-3174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0237271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical