Healthcare Provider Details

I. General information

NPI: 1891403184
Provider Name (Legal Business Name): ANDRES WATERS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 OLD HARMONY RD STE E
NEWARK DE
19713-4161
US

IV. Provider business mailing address

930 OLD HARMONY RD STE E
NEWARK DE
19713-4161
US

V. Phone/Fax

Practice location:
  • Phone: 302-588-4482
  • Fax:
Mailing address:
  • Phone: 302-588-4482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ1-0012158
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: