Provider Demographics
NPI:1447425913
Name:WATERHOUSE, GARET DAVID (LCSW)
Entity Type:Individual
Prefix:
First Name:GARET
Middle Name:DAVID
Last Name:WATERHOUSE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1585 TERRACE WAY, #115
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-3066
Mailing Address - Country:US
Mailing Address - Phone:707-387-4525
Mailing Address - Fax:
Practice Address - Street 1:3438 MENDOCINO AVE # B
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2275
Practice Address - Country:US
Practice Address - Phone:707-387-4525
Practice Address - Fax:707-861-9292
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2021-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS245601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical