Provider Demographics
NPI:1801394309
Name:WATERHOUSE, STEPHANIE JULIANNA (RPA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JULIANNA
Last Name:WATERHOUSE
Suffix:
Gender:F
Credentials:RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9707 KEY WEST AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3992
Mailing Address - Country:US
Mailing Address - Phone:240-750-6467
Mailing Address - Fax:
Practice Address - Street 1:9707 KEY WEST AVE STE 100
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3992
Practice Address - Country:US
Practice Address - Phone:240-750-6467
Practice Address - Fax:240-702-0262
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2021-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
MDA0609103TC1900X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling