Active NPI
Kimberly Sue Waters, MS-LLP
- Clinical Psychologist
- Livonia, MI
National Provider Identifier
1629255567
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301008077
- Practice address
- 33180 Industrial Rd Ste 300
Livonia, MI 48150-4200 - Phone
- (248) 514-2290
- NPI assigned
- Jan 23, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6301008077 | MI | Primary |
Addresses
Primary practice location
33180 Industrial Rd Ste 300
Livonia, MI 48150-4200
Mailing address
33493 W 14 Mile Rd
Suite 130
Farmington Hills, MI 48331-1587
Phone (248) 851-5437
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301008077 | MI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1201046400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1629417600000",
"number": "1629255567",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "33493 W 14 MILE RD",
"address_2": "SUITE 130",
"city": "FARMINGTON HILLS",
"state": "MI",
"postal_code": "483311587",
"telephone_number": "248-851-5437",
"fax_number": "248-592-1378"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "33180 INDUSTRIAL RD STE 300",
"city": "LIVONIA",
"state": "MI",
"postal_code": "481504200",
"telephone_number": "248-514-2290"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATERS",
"first_name": "KIMBERLY",
"middle_name": "SUE",
"credential": "MS-LLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-01-23",
"last_updated": "2021-08-20",
"certification_date": "2021-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301008077",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Livonia, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.