Provider Demographics
NPI:1427375906
Name:WATERMAN, JASON STERRY (PSYD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:STERRY
Last Name:WATERMAN
Suffix:
Gender:M
Credentials:PSYD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 FLORENCITA AVE
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1817
Mailing Address - Country:US
Mailing Address - Phone:626-833-3825
Mailing Address - Fax:
Practice Address - Street 1:2303 FLORENCITA AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CA
Practice Address - Zip Code:91020-1817
Practice Address - Country:US
Practice Address - Phone:626-833-3825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 38531106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist