Blue Waters Family Counseling, S.C.

Primary specialty

CounselorTaxonomy code 101Y00000X

Legal business name

BLUE WATERS FAMILY COUNSELING, S.C.

Practice address

2215 Washington St
Manitowoc, WI 54220-4847

Phone

(920) 683-3911

Fax

(920) 683-3411

NPI assigned

Aug 18, 2006

Last updated

Feb 8, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Diane M Berry, MSW LCSW JDNPI 1982610986

Title

Director

Phone

(920) 683-3911

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Diane M Berry, MSW

  • Clinical Social Worker
  • Manitowoc, WI
  • NPI 1982610986
  Authorized official Same address or phone
• Robert A Dickens, MD

  • Psychiatry Physician
  • Milwaukee, WI
  • NPI 1831173673
  NPD (past)

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328659200000",
    "number": "1366556359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2215 WASHINGTON ST",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542204847",
            "telephone_number": "920-683-3911",
            "fax_number": "920-683-3411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2215 WASHINGTON ST",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542204847",
            "telephone_number": "920-683-3911",
            "fax_number": "920-683-3411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE WATERS FAMILY COUNSELING, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-18",
        "last_updated": "2012-02-08",
        "status": "A",
        "authorized_official_last_name": "BERRY",
        "authorized_official_first_name": "DIANE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "920-683-3911",
        "authorized_official_credential": "MSW LCSW JD"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42217300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Better Beginnings, LLC
• Krishna Bhatt, M.D.
• Bio-Medical Applications of Wisconsin, Inc. (Fresenius Medical Care Manitowoc)
• Craig Bishop
• Sheana Blackmon
• Daniel R Boettcher, DDS
• Julia A Boldt, PTA
• Shannon Marie Bolick
• Lori A Bonin, PT
• Michael Bonin

• Counselor in Manitowoc, WI
• Providers in Manitowoc, WI by specialty
• Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.