Individual
DR. CHARLES BRENT WASSERMAN SR.
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PH. D.
Contact information
Practice address
19542 MAYALL ST, NORTHRIDGE, CA 91324-1014
(818) 718-9705
(818) 718-2276
Mailing address
19542 MAYALL ST, NORTHRIDGE, CA 91324-1014
(818) 718-9705
(818) 718-2276
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY5722
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00PL57220
LOS ANGELES COUNTY DMH
CA
05
—
00PL57220
—
CA
Enumeration date
10/28/2005
Last updated
07/09/2007
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