Provider Demographics
NPI:1487634655
Name:WASSERMAN, KIMBERLY L (PHD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:L
Last Name:WASSERMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-1008
Mailing Address - Country:US
Mailing Address - Phone:610-715-2511
Mailing Address - Fax:
Practice Address - Street 1:105 S HIGH ST
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-1008
Practice Address - Country:US
Practice Address - Phone:610-715-2511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-22
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-005912-L103TC0700X
PAPS005912L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical