Provider Information for 1912351883
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JASON VANDEWATER LCSW
Sex: Male
NPI: 1912351883
Last Updated: 2016-04-18
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1912351883 | ||||||||
| Enumeration Date | 2016-04-18 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1 FARMINGDALE ROAD WEST BBABYLON, NY 11704 United States Phone: 631-669-5355 | Fax: | ||||||||
| Primary Practice Address | 1 FARMINGDALE ROAD WEST BBABYLON, NY 11704 United States Phone: 631-669-5355 | Fax: | ||||||||
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