Provider Demographics
NPI:1134286263
Name:WATERS, MAUREEN (LCSW LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:
Last Name:WATERS
Suffix:
Gender:F
Credentials:LCSW LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1717
Mailing Address - Country:US
Mailing Address - Phone:732-533-7845
Mailing Address - Fax:
Practice Address - Street 1:145 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1717
Practice Address - Country:US
Practice Address - Phone:732-533-7845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC045828001041C0700X
NJ37FI00046800106H00000X
NJ1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ246084UBSOtherUNITED BEHAVORIAL HEALTH
NJ6056903Medicaid
NJ266688000OtherMAGELLAN NUMBER
NJWA740485Medicare ID - Type Unspecified
NJ740485BSUMedicare PIN