Provider Demographics
NPI:1841406634
Name:WATERS, CATHERINE CECELIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:CECELIA
Last Name:WATERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5229
Mailing Address - Country:US
Mailing Address - Phone:908-810-0307
Mailing Address - Fax:
Practice Address - Street 1:9 RYERSON AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-6109
Practice Address - Country:US
Practice Address - Phone:973-618-3658
Practice Address - Fax:973-618-3443
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00115200101YP2500X
NJ35S100206600103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ098390Medicare ID - Type Unspecified