Provider Demographics
NPI:1336347046
Name:WATERS, CYNTHIA A (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:A
Last Name:WATERS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W. CHURCH STREET, SUITE C
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801
Mailing Address - Country:US
Mailing Address - Phone:410-572-5767
Mailing Address - Fax:
Practice Address - Street 1:110 W. CHURCH STREET, SUITE C
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801
Practice Address - Country:US
Practice Address - Phone:443-497-2044
Practice Address - Fax:410-749-1589
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG12878104100000X
MD19328104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD609500300Medicaid
MD259147-000OtherMAGELLAN (GROUP)
MD609500303Medicaid
MD609550004Medicaid
MD609550001Medicaid
MD609550002Medicaid
MD517251OtherUHCMAMSI (GROUP)
MDLM49EAOtherCAREFIRST BCBS (GROUP)
MDR968OtherCAREFIRST FEDERAL (GROUP)
MD609500303Medicaid