Provider Demographics
NPI:1285985812
Name:WASSERSTEIN, BERENA DYAN (ATR-BC, LCAT, ACSW)
Entity type:Individual
Prefix:MS
First Name:BERENA
Middle Name:DYAN
Last Name:WASSERSTEIN
Suffix:
Gender:
Credentials:ATR-BC, LCAT, ACSW
Other - Prefix:MRS
Other - First Name:BERENA
Other - Middle Name:DYAN
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATR-BC, LCAT, ACSW
Mailing Address - Street 1:PO BOX 47
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92038-0047
Mailing Address - Country:US
Mailing Address - Phone:646-883-6454
Mailing Address - Fax:
Practice Address - Street 1:109 N 12TH ST FL 7
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11249-1008
Practice Address - Country:US
Practice Address - Phone:646-883-6454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-22
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1291321041C0700X
NY001240221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist