Provider Demographics
NPI:1194508754
Name:WATERMAN, JASON TODD (LMSW, LCSWA)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:TODD
Last Name:WATERMAN
Suffix:
Gender:M
Credentials:LMSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2880 SLATER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-6400
Mailing Address - Country:US
Mailing Address - Phone:484-682-9281
Mailing Address - Fax:
Practice Address - Street 1:2880 SLATER RD
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-6400
Practice Address - Country:US
Practice Address - Phone:484-682-9281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-17
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30563104100000X
NCP020375104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker