Provider Demographics
NPI:1104433663
Name:WATER EDGE THERAPY LLC
Entity type:Organization
Organization Name:WATER EDGE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEDDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-740-7205
Mailing Address - Street 1:23 BROWN ST STE 107
Mailing Address - Street 2:
Mailing Address - City:N KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-5037
Mailing Address - Country:US
Mailing Address - Phone:508-740-7205
Mailing Address - Fax:508-484-9421
Practice Address - Street 1:23 BROWN ST STE 107
Practice Address - Street 2:
Practice Address - City:N KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-5037
Practice Address - Country:US
Practice Address - Phone:508-740-7205
Practice Address - Fax:508-484-9421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty