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General NPI Number Information
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NPI Number | 1780158030
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Entity Type | Individual
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Provider Name | DEBRA KAY WATERS-ROMAN LCP
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Gender | Female
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Dates
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Enumeration Date | 01/18/2019
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Last Update Date | 01/18/2019
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Provider Practice Location Address
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Address Line | 17814 WOODRUFF AVE STE 3
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City | BELLFLOWER
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State | CA
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Zip | 90706-7000
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Country | US
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Telephone | 714-585-3313
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Fax |
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Provider Business Mailing Address
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Address Line | 610 THORNHURST AVE
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City | GLENDORA
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State | CA
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Zip | 91741-2364
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Country | US
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Telephone | 626-482-7017
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PSY27444
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License Number State | CA
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