Healthcare Provider Details

I. General information

NPI: 1053761270
Provider Name (Legal Business Name): WATERS EDGE THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2016
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325D KENNEDY MEMORIAL DR
WATERVILLE ME
04901-4530
US

IV. Provider business mailing address

325D KENNEDY MEMORIAL DR
WATERVILLE ME
04901-4530
US

V. Phone/Fax

Practice location:
  • Phone: 207-616-0499
  • Fax: 207-616-0227
Mailing address:
  • Phone: 207-616-0499
  • Fax: 207-616-0227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateME

VIII. Authorized Official

Name: MS. DIANNE M HOWARD MORAND
Title or Position: CLINICIAN
Credential: LCSW
Phone: 207-530-0880