Provider Demographics
NPI:1730946773
Name:WATERFORD UNIFIED SCHOOL DISTRICT
Entity type:Organization
Organization Name:WATERFORD UNIFIED SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:VISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-874-1809
Mailing Address - Street 1:219 N REINWAY AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CA
Mailing Address - Zip Code:95386-8906
Mailing Address - Country:US
Mailing Address - Phone:209-874-1809
Mailing Address - Fax:
Practice Address - Street 1:121 S REINWAY AVE
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CA
Practice Address - Zip Code:95386-9629
Practice Address - Country:US
Practice Address - Phone:209-874-9060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251300000XAgenciesLocal Education Agency (LEA)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty