Healthcare Provider Details

I. General information

NPI: 1841701455
Provider Name (Legal Business Name): DEBBIE WATERMAN, PHD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 10/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1546 MCDANIEL DR
WEST CHESTER PA
19380-7035
US

IV. Provider business mailing address

1546 MCDANIEL DRIVE
WEST CHESTER PA
19380
US

V. Phone/Fax

Practice location:
  • Phone: 610-399-7057
  • Fax:
Mailing address:
  • Phone: 610-399-7057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPS015001
License Number StatePA

VIII. Authorized Official

Name: DR. DEBORAH ELLYN WATERMAN
Title or Position: PSYCHOLOGIST/OWNER
Credential: PHD
Phone: 610-399-7057