Provider Demographics
NPI:1568907814
Name:LUDWIG WATARI, NANCY ANN (LMHC)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:ANN
Last Name:LUDWIG WATARI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:DR
Other - First Name:NANCY
Other - Middle Name:ANN
Other - Last Name:LUDWIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:657 CASTLETON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-2028
Mailing Address - Country:US
Mailing Address - Phone:917-602-1782
Mailing Address - Fax:
Practice Address - Street 1:657 CASTLETON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-2028
Practice Address - Country:US
Practice Address - Phone:917-602-1782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004628101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health