Provider Demographics
NPI:1003017740
Name:WATERS, CHRISTY A (MHS CSW)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:A
Last Name:WATERS
Suffix:
Gender:F
Credentials:MHS CSW
Other - Prefix:MS
Other - First Name:CHRISTY
Other - Middle Name:A
Other - Last Name:MCNALLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:177 WILD OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NJ
Mailing Address - Zip Code:08079-3350
Mailing Address - Country:US
Mailing Address - Phone:856-878-9011
Mailing Address - Fax:856-878-9012
Practice Address - Street 1:1868 GREENTREE ROAD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003
Practice Address - Country:US
Practice Address - Phone:856-424-4408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SW00345300390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program