Provider Demographics
NPI:1568854321
Name:WATERS EDGE THERAPY, INC.
Entity Type:Organization
Organization Name:WATERS EDGE THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOWARD-MORAND
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-530-0880
Mailing Address - Street 1:8 WATER ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:OAKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04963-4956
Mailing Address - Country:US
Mailing Address - Phone:207-530-0880
Mailing Address - Fax:
Practice Address - Street 1:8 WATER ST
Practice Address - Street 2:SUITE 2
Practice Address - City:OAKLAND
Practice Address - State:ME
Practice Address - Zip Code:04963-4956
Practice Address - Country:US
Practice Address - Phone:207-530-0880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1356619670OtherMAINE CARE
ME1356619670OtherMEDICARE
ME1356619670OtherMAINE COMMUNITY HEALTH OPTIONS
ME1356619670OtherUNITED HEALTH CARE
ME1356619670OtherAPS HEALTHCARE
ME1356619670OtherANTHEM
ME1356619670OtherMARTINS POINT
ME1356619670OtherCHAMP VA
ME1356619670OtherBLUE CROSS BLUE SHIELD
ME1356619670OtherAETNA
ME1356619670OtherCIGNA
ME1356619670OtherCAQH 12661845