Provider Demographics
NPI:1740825140
Name:WATERS, LAUREN M (DUAL MA)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:M
Last Name:WATERS
Suffix:
Gender:F
Credentials:DUAL MA
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:M
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DUAL MA
Mailing Address - Street 1:1 INDIAN WELL CT
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-5748
Mailing Address - Country:US
Mailing Address - Phone:516-946-8149
Mailing Address - Fax:
Practice Address - Street 1:1 INDIAN WELL CT
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-5748
Practice Address - Country:US
Practice Address - Phone:516-946-8149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-10
Last Update Date:2019-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY808325101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor