Healthcare Provider Details

I. General information

NPI: 1487442612
Provider Name (Legal Business Name): NORA FRANCES WATERS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 PROSPECT AVE FL 5
HUDSON NY
12534-2927
US

IV. Provider business mailing address

11 MONTGOMERY ST
TIVOLI NY
12583-5744
US

V. Phone/Fax

Practice location:
  • Phone: 518-697-8010
  • Fax:
Mailing address:
  • Phone: 414-379-6401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number126887
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: