Provider Demographics
NPI:1063020758
Name:WATERS, SIMONE (LSW)
Entity Type:Individual
Prefix:
First Name:SIMONE
Middle Name:
Last Name:WATERS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 AIMWICK CT
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-4734
Mailing Address - Country:US
Mailing Address - Phone:848-229-4412
Mailing Address - Fax:
Practice Address - Street 1:16 EMERSON ST
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-4400
Practice Address - Country:US
Practice Address - Phone:848-229-4412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-19
Last Update Date:2020-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSW-GTL-20-011351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical