Provider Demographics
NPI:1558011437
Name:WATERS, DEVORAH NAOMI (LICSW)
Entity Type:Individual
Prefix:
First Name:DEVORAH
Middle Name:NAOMI
Last Name:WATERS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6375 NW 77TH PL
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-2405
Mailing Address - Country:US
Mailing Address - Phone:718-541-1100
Mailing Address - Fax:
Practice Address - Street 1:6375 NW 77TH PL
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33067-2405
Practice Address - Country:US
Practice Address - Phone:718-541-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN236111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical