Healthcare Provider Details

I. General information

NPI: 1750656476
Provider Name (Legal Business Name): NADIA WATERMAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2012
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 N SHEFFIELD AVE
CHICAGO IL
60657-2210
US

IV. Provider business mailing address

3727 N SEMINARY AVE FLOOR 1
CHICAGO IL
60613-3817
US

V. Phone/Fax

Practice location:
  • Phone: 773-549-5886
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number178007165
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: