Provider Demographics
NPI:1922469345
Name:WATERS, STEPHANIE CHAPMAN (LSW)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:CHAPMAN
Last Name:WATERS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-1062
Mailing Address - Country:US
Mailing Address - Phone:570-342-8434
Mailing Address - Fax:570-319-5949
Practice Address - Street 1:406 N STATE ST
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-1062
Practice Address - Country:US
Practice Address - Phone:570-342-8434
Practice Address - Fax:570-319-5949
Is Sole Proprietor?:No
Enumeration Date:2016-03-12
Last Update Date:2016-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW133060104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker