Provider Demographics
NPI:1861600587
Name:WATERS, ANNE WELLES (PSYD)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:WELLES
Last Name:WATERS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 WASHINGTON ST APT 6
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-2237
Mailing Address - Country:US
Mailing Address - Phone:617-965-8523
Mailing Address - Fax:
Practice Address - Street 1:11 WASHINGTON ST APT 6
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-2237
Practice Address - Country:US
Practice Address - Phone:617-965-8523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4646103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist