Healthcare Provider Details

I. General information

NPI: 1528394616
Provider Name (Legal Business Name): JANIS WATERS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2009
Last Update Date: 07/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 DEAL RD
OCEAN NJ
07712-3622
US

IV. Provider business mailing address

601 DEAL RD
OCEAN NJ
07712-3622
US

V. Phone/Fax

Practice location:
  • Phone: 732-531-2600
  • Fax:
Mailing address:
  • Phone: 732-531-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00383100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: