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Individual

JOHN M WATERMAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
CASAC

Contact information

Practice address
475 E MAIN ST, SUITE 1, PATCHOGUE, NY 11772-3121
(631) 363-2001
(631) 702-8050
Mailing address
657 S COUNTRY RD, E PATCHOGUE, NY 11772-5550
(631) 371-2680
(631) 702-8050

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
25901
NY

Other

Enumeration date
01/07/2015
Last updated
01/07/2015
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