Kelly J Waters, MSW, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904005930 Issued in VA

Practice address

1503 Santa Rosa Rd
Suite 211
Richmond, VA 23229-5105

Phone

(804) 289-9100

NPI assigned

Jul 13, 2010

Last updated

Aug 14, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Bon Secours-St. Mary's Hospital of Richmond, Inc.

  dba Bon Secours Infectious Disease Specialists

  • Infectious Disease Physician
  • Richmond, VA
  • NPI 1063772143
  NPD (past)

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

{
    "created_epoch": "1278979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344902400000",
    "number": "1841502366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1503 SANTA ROSA RD",
            "address_2": "SUITE 211",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232295105",
            "telephone_number": "804-289-9100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1503 SANTA ROSA RD",
            "address_2": "SUITE 211",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232295105",
            "telephone_number": "804-289-9100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERS",
        "first_name": "KELLY",
        "middle_name": "J",
        "credential": "MSW, LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-13",
        "last_updated": "2012-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904005930",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PTAN",
            "identifier": "C06778",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Luc F Watelet, LPC
• Elizabeth Waterhouse, M.D.
• Charnetta Rochelle Waters-Mason, MA, LPC
• Haidee F Waters, NP
• Karen A Waters, PH.D.
• Linda B Waterworth, ANP
• Alethia Nicole Watford, LCSW
• Aimee J Watkins, NP
• Bethany Bray Floyd Watkins
• Harold L Watkins II, M.S.W., M.P.A

• Clinical Social Worker in Richmond, VA
• Providers in Richmond, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 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.