Healthcare Provider Details

I. General information

NPI: 1699496877
Provider Name (Legal Business Name): MADELEINE WATERS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 E DEDHAM ST
BOSTON MA
02118-2315
US

IV. Provider business mailing address

134 CHARLTON RD
SPENCER MA
01562-2725
US

V. Phone/Fax

Practice location:
  • Phone: 617-267-3700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC10004817
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: