Active NPI
Jack Saul Wasserman, PH.D
- Clinical Psychologist
- Newport Beach, CA
National Provider Identifier
1225134893
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 11898
- Practice address
- 1101 Dove St
Newport Beach, CA 92660-2839 - Phone
- (714) 812-6869
- NPI assigned
- Sep 14, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Psychologist | 103TA0400X | PSY11898 | CA | |
| Clinical Psychologist | 103TC0700X | 11898 | CA | Primary |
Addresses
Primary practice location
1101 Dove St
Newport Beach, CA 92660-2839
Mailing address
1101 Dove St
Newport Beach, CA 92660-2839
Phone (714) 812-6869
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225134893 | Other | CA | 103TA0400X |
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY11898 | CA | MD | Addiction (Substance Use Disorder) Psychologist |
| 11898 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548115200000",
"number": "1225134893",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1101 DOVE ST",
"city": "NEWPORT BEACH",
"state": "CA",
"postal_code": "926602839",
"telephone_number": "714-812-6869"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1101 DOVE ST",
"city": "NEWPORT BEACH",
"state": "CA",
"postal_code": "926602839",
"telephone_number": "714-812-6869"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WASSERMAN",
"first_name": "JACK",
"middle_name": "SAUL",
"name_prefix": "Dr.",
"credential": "PH.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-14",
"last_updated": "2019-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "103TA0400X",
"taxonomy_group": "",
"desc": "Psychologist, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "PSY11898",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "11898",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "103TA0400X",
"identifier": "1225134893",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Newport Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.