Individual
BLAIRE WATERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2261 MARKET STREET, SAN FRANCISCO, CA 94114-1612
(415) 226-9284
(866) 228-2328
Mailing address
450 E SAGEBRUSH DR UNIT N11, JACKSON, WY 83001-8204
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
113983
CA
1041C0700X
Clinical Social Worker
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
377896YLFK
—
CO
Enumeration date
08/09/2012
Last updated
03/13/2023
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