Individual
BARBARA WISSEMANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1844 ROUTE 112 STE A, CORAM, NY 11727-2337
(631) 736-7707
Mailing address
21 RENEE PL, MASSAPEQUA PARK, NY 11762-3522
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
078729-1
NY
Other
Enumeration date
07/29/2019
Last updated
07/29/2019
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