Basic Information
| Provider Information | |||||||||
| NPI: | 1528072790 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WATERS | ||||||||
| FirstName: | DEIRDRE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 253 MAIN ST | ||||||||
| Address2: | SUITE 111 | ||||||||
| City: | MATAWAN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077473222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7323348138 | ||||||||
| FaxNumber: | 7326434378 | ||||||||
| Practice Location | |||||||||
| Address1: | 37 VILLAGE CT | ||||||||
| Address2: | |||||||||
| City: | HAZLET | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077301534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7323348138 | ||||||||
| FaxNumber: | 7326434378 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 03/04/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 4555 | NJ | N | Behavioral Health & Social Service Providers | Psychologist | 103T00000X | 4445 | NJ | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.