Provider Demographics
NPI:1851648208
Name:WATERS, CARLY-JAYNE (LCSW, CAP)
Entity type:Individual
Prefix:MS
First Name:CARLY-JAYNE
Middle Name:
Last Name:WATERS
Suffix:
Gender:F
Credentials:LCSW, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 OSLO AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33026-4702
Mailing Address - Country:US
Mailing Address - Phone:954-868-7092
Mailing Address - Fax:
Practice Address - Street 1:1201 N 37TH AVE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5414
Practice Address - Country:US
Practice Address - Phone:954-962-1355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4680101YA0400X
FLSW98301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)