Healthcare Provider Details

I. General information

NPI: 1053215376
Provider Name (Legal Business Name): CARSON JANIE-MISHIE WATERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2299 WOODBURY AVE STE 1
NEWINGTON NH
03801-7854
US

IV. Provider business mailing address

37A LOWER MAIN ST
NORTH BERWICK ME
03906-6714
US

V. Phone/Fax

Practice location:
  • Phone: 603-244-3187
  • Fax:
Mailing address:
  • Phone: 603-923-9914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: