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General NPI Number Information
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NPI Number | 1144570474
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Entity Type | Individual
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Provider Name | AMANDA JOY WATERS M.A.
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Gender | Female
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Dates
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Enumeration Date | 09/13/2012
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Last Update Date | 01/11/2017
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Provider Practice Location Address
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Address Line | 1720 E 120TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90059-3052
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Country | US
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Telephone | 310-668-3096
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Fax | 310-223-0910
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Provider Business Mailing Address
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Address Line | 75 HOCKANUM BLVD UNIT 735
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City | VERNON
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State | CT
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Zip | 06066-4056
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 003624
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License Number State | CT
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