Richard Stephen Waters, PSY. D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

10058 Issued in MA

Practice address

650 Lincoln St
Worcester, MA 01605-2060

Phone

(508) 595-0750

Fax

(508) 595-1130

NPI assigned

Sep 3, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MA

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, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Edward M Kennedy Community Health Center IncGroup PAC ID 3476512740, 65 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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 and National Provider Directory roles.

• Edward M. Kennedy Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Worcester, MA
  • NPI 1609842152
  Medicare reassignment Care Compare group NPD
• Edward M. Kennedy Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Worcester, MA
  • NPI 1316324650
  NPD
• Edward M. Kennedy Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Milford, MA
  • NPI 1992137426
  NPD (past)

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

{
    "created_epoch": "1283472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491177600000",
    "number": "1629385224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 LINCOLN ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016052060",
            "telephone_number": "508-532-2200",
            "fax_number": "508-853-8593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 LINCOLN ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016052060",
            "telephone_number": "508-595-0750",
            "fax_number": "508-595-1130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERS",
        "first_name": "RICHARD",
        "middle_name": "STEPHEN",
        "name_prefix": "Mr.",
        "credential": "PSY. D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-09-03",
        "last_updated": "2017-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "10058",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101YA0400X",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Passy Muaua Wasso
• Iona Jean Waterhouse, LMHC
• Watering Wellness and Healing Therapy Services PLLC
• Asim Waters
• Madeleine Waters, BA
• Simon Hayward Waters, PH.D.
• Evan A Watkins, M.D.
• Jade Elizabeth Watkins, M.D.
• Maureen K Watkins, PT, DPT
• Alexander Jamal Watson, LCSW

• Clinical Psychologist in Worcester, MA
• Providers in Worcester, MA by specialty
• Clinical Psychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2017; 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.