Provider Demographics
NPI:1588271274
Name:WATERS, SIMON HAYWARD (PHD)
Entity type:Individual
Prefix:
First Name:SIMON
Middle Name:HAYWARD
Last Name:WATERS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 ROCKRIMMON RD
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-2231
Mailing Address - Country:US
Mailing Address - Phone:508-754-6723
Mailing Address - Fax:
Practice Address - Street 1:67 ROCKRIMMON RD
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-2231
Practice Address - Country:US
Practice Address - Phone:508-754-6723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-26
Last Update Date:2020-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA231372691OtherESWA