Active NPI
Pamela B Wasserman, PSYD
- Clinical Psychologist
- Syosset, NY
National Provider Identifier
1043589575
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 015296-1
- Practice address
- 115 Eileen Way
Syosset, NY 11791-5325 - Phone
- (516) 695-9814
- NPI assigned
- Dec 29, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 015296-1 | NY | Primary |
| Clinical Psychologist | 103TC0700X | 071005405 | IL |
Addresses
Primary practice location
115 Eileen Way
Syosset, NY 11791-5325
Mailing address
115 Eileen Way
Syosset, NY 11791-5325
Phone (516) 695-9814
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071005405 | IL | MD | Clinical Psychologist |
| 015296-1 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1325116800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1365897600000",
"number": "1043589575",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "115 EILEEN WAY",
"city": "SYOSSET",
"state": "NY",
"postal_code": "117915325",
"telephone_number": "516-695-9814"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 EILEEN WAY",
"city": "SYOSSET",
"state": "NY",
"postal_code": "117915325",
"telephone_number": "516-695-9814"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WASSERMAN",
"first_name": "PAMELA",
"middle_name": "B",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-12-29",
"last_updated": "2013-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "015296-1",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071005405",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Syosset, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.