Provider Demographics
NPI:1922795905
Name:WATERS, TAYLOR (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:WATERS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 E PARK DR STE 206
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-2800
Mailing Address - Country:US
Mailing Address - Phone:717-421-7629
Mailing Address - Fax:717-430-0757
Practice Address - Street 1:940 E PARK DR STE 206
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-2800
Practice Address - Country:US
Practice Address - Phone:717-421-7629
Practice Address - Fax:717-430-0757
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0235451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical