Provider Demographics
NPI:1053052282
Name:WATERS, MARY-CAROL B (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY-CAROL
Middle Name:B
Last Name:WATERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-1616
Mailing Address - Country:US
Mailing Address - Phone:617-680-4764
Mailing Address - Fax:
Practice Address - Street 1:1530 RIVER ST
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-1616
Practice Address - Country:US
Practice Address - Phone:617-680-4764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-03
Last Update Date:2022-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2231011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical