Individual
JENNIFER WATERMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
96 INDIA ST, PORTLAND, ME 04101-4230
(207) 772-2202
Mailing address
96 INDIA ST, PORTLAND, ME 04101-4230
(207) 772-2202
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CC2553
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
417990099
—
ME
Enumeration date
03/02/2007
Last updated
07/05/2016
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