Mary Waters, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY 4135 Issued in FL

Practice address

2509 Barrington Cir Ste 109
Tallahassee, FL 32308-6801

Phone

(850) 385-1190

NPI assigned

Mar 17, 2008

Last updated

Mar 17, 2008By 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

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Optum Behavioral Care of North Carolina PCGroup PAC ID 5092120030, 175 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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.

• Optum Behavioral Care of North Carolina, PC

  • Counseling Psychologist
  • Sarasota, FL
  • NPI 1033984448
  Medicare reassignment Care Compare group
• Waters & Kaklamanos

  • Clinical Psychologist
  • Tallahassee, FL
  • NPI 1346592748
  Authorized official Same address or phone

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

{
    "created_epoch": "1205712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205712000000",
    "number": "1215108329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2509 BARRINGTON CIR STE 109",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323086801",
            "telephone_number": "850-385-1190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2509 BARRINGTON CIR STE 109",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323086801",
            "telephone_number": "850-385-1190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERS",
        "first_name": "MARY",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-03-17",
        "last_updated": "2008-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY 4135",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Waters & Kaklamanos
• Waters & Kaklamanos, LLC
• Keely Waters Kaklamanos, PH.D.
• Chrystal Waters, CRNA
• Lavonda Yvette Waters, MS
• Vanessa Lauren Waters, MS, CF-SLP
• S Kimberly Watford, LCWS, MSW
• Christina Watkins
• Regina Watkins, MS
• Zania Watkins

• Clinical Psychologist in Tallahassee, FL
• Providers in Tallahassee, FL by specialty
• Clinical Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.