Provider Demographics
NPI:1528072790
Name:WATERS, DEIRDRE (PSYD)
Entity type:Individual
Prefix:DR
First Name:DEIRDRE
Middle Name:
Last Name:WATERS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 MAIN ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-3222
Mailing Address - Country:US
Mailing Address - Phone:732-334-8138
Mailing Address - Fax:732-643-4378
Practice Address - Street 1:37 VILLAGE CT
Practice Address - Street 2:
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1534
Practice Address - Country:US
Practice Address - Phone:732-334-8138
Practice Address - Fax:732-643-4378
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4555103T00000X
NJ4445103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist