Provider Demographics
NPI:1215250030
Name:WATERS, JAMIKA
Entity type:Individual
Prefix:MS
First Name:JAMIKA
Middle Name:
Last Name:WATERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 W TOWNSHIP LINE RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-5237
Mailing Address - Country:US
Mailing Address - Phone:267-549-7609
Mailing Address - Fax:
Practice Address - Street 1:410 W TOWNSHIP LINE RD
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-5237
Practice Address - Country:US
Practice Address - Phone:267-549-7609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst