Provider Demographics
NPI:1306928114
Name:WASSERBERG, EMILY WASSERBERG (LCSW)
Entity type:Individual
Prefix:MS
First Name:EMILY
Middle Name:WASSERBERG
Last Name:WASSERBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5550 FIELDSTON RD
Mailing Address - Street 2:8A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-2521
Mailing Address - Country:US
Mailing Address - Phone:347-275-1304
Mailing Address - Fax:
Practice Address - Street 1:55 WESTCHESTER SQ
Practice Address - Street 2:JBFCS BRONX REAL ICM
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3525
Practice Address - Country:US
Practice Address - Phone:718-931-4045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072123-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical