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General NPI Number Information
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NPI Number | 1104433663
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Entity Type | Organization
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Legal Business Name | WATERS EDGE THERAPY LLC
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Dates
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Enumeration Date | 09/29/2020
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Last Update Date | 01/28/2026
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Provider Practice Location Address
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Address Line | 1130 TEN ROD RD STE F206
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City | N KINGSTOWN
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State | RI
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Zip | 02852-4172
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Country | US
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Telephone | 508-740-7205
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Fax | 508-484-9421
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Provider Business Mailing Address
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Address Line | 1130 TEN ROD RD STE F206
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City | N KINGSTOWN
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State | RI
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Zip | 02852-4172
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Country | US
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Telephone | 401-267-2954
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Fax | 508-484-9421
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Authorized Official
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Title or Position | BILLER
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Name | CHRISTINE HEDDING
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Credential |
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Telephone | 508-740-7205
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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