Provider Demographics
NPI:1275359754
Name:WATERS, ANNA KATHERINE KIM
Entity type:Individual
Prefix:
First Name:ANNA KATHERINE
Middle Name:KIM
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 1:103 KATHLEEN TER
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-1251
Mailing Address - Country:US
Mailing Address - Phone:315-350-7283
Mailing Address - Fax:
Practice Address - Street 1:8195 CAZENOVIA RD
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-9631
Practice Address - Country:US
Practice Address - Phone:315-350-7283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-29
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist