Provider Demographics
NPI:1932253135
Name:WATERHOUSE, JANET CHRISTINE (PHD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:CHRISTINE
Last Name:WATERHOUSE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W 57TH ST STE 305
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3148
Mailing Address - Country:US
Mailing Address - Phone:917-239-7792
Mailing Address - Fax:
Practice Address - Street 1:315 W 57TH ST STE 305
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3148
Practice Address - Country:US
Practice Address - Phone:917-239-7792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP47393103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP47393OtherPSYCHOLOGY