Provider Demographics
NPI:1477976728
Name:WATERS, ANNELIESE KIRSTEN (MSW)
Entity type:Individual
Prefix:
First Name:ANNELIESE
Middle Name:KIRSTEN
Last Name:WATERS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:ANNELIESE
Other - Middle Name:KIRSTEN
Other - Last Name:GASKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:820 6TH ST
Mailing Address - Street 2:
Mailing Address - City:WASCO
Mailing Address - State:CA
Mailing Address - Zip Code:93280-1948
Mailing Address - Country:US
Mailing Address - Phone:661-758-4029
Mailing Address - Fax:850-595-0180
Practice Address - Street 1:820 6TH ST
Practice Address - Street 2:
Practice Address - City:WASCO
Practice Address - State:CA
Practice Address - Zip Code:93280-1948
Practice Address - Country:US
Practice Address - Phone:661-758-4029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-22
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA100033104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health