Provider Demographics
NPI:1962784942
Name:WATTERS, ROSE MARIE (CSW)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:MARIE
Last Name:WATTERS
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:MARIE
Other - Last Name:SULLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1382 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40208-2351
Mailing Address - Country:US
Mailing Address - Phone:502-561-1051
Mailing Address - Fax:502-587-7145
Practice Address - Street 1:1382 S 3RD ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208-2351
Practice Address - Country:US
Practice Address - Phone:502-561-1051
Practice Address - Fax:502-587-7145
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health