Carolyn Waterfall, LPCI

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

R4777 Issued in OR

Practice address

12332 SW 72ND Ave Ste 113
Portland, OR 97223-8688

Phone

(503) 686-3918

NPI assigned

Jul 7, 2017

Reactivated

Jan 26, 2022

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Apr 7, 2024 through Apr 7, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Carolyn Waterfall Ms LPC LLC

  • Mental Health Counselor
  • Oregon City, OR
  • NPI 1083374805
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1499385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1184146565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12332 SW 72ND AVE APT 113",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972238688",
            "telephone_number": "503-686-3918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12332 SW 72ND AVE STE 113",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972238688",
            "telephone_number": "503-686-3918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERFALL",
        "first_name": "CAROLYN",
        "credential": "LPCI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-07-07",
        "last_updated": "2022-07-21",
        "certification_date": "2022-01-26",
        "deactivation_date": "2021-12-21",
        "reactivation_date": "2022-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OR",
            "license": "R4777",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joel D Wasserman, D.D.S.
• Sydney Rose Wasserman
• Pesha Wasserstrom
• Saera Watanabe, MD
• Watercourse Wellness
• Katharyn Waterfield, MA, LPC
• Iris M Waterlin, LMT
• Claire Ashley Waterman, M.S.
• Cristina L Waterman, DMD
• Emily Waterman, M.D.

• Professional Counselor in Portland, OR
• Providers in Portland, OR by specialty
• Professional Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.