Individual provider Active NPI

Jessica Waterman, LCSW

  • Clinical Social Worker
  • Latham, NY
National Provider Identifier
1902355159
Registry record updated Jul 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
090268
Practice address
4 Avis Dr Ste 101
Latham, NY 12110-2650
Phone
(518) 560-4277
Fax
(518) 662-4277
NPI assigned
Sep 29, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 090268 Primary

Addresses

Primary practice location

4 Avis Dr Ste 101
Latham, NY 12110-2650

Mailing address

1721 Central Ave
Colonie, NY 12205-4799
Phone (518) 903-9671

Other practice location 1

1721 Central Ave
Colonie, NY 12205-4799
Phone (518) 903-9671

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

Practice roles

OrganizationSpecialtyStatusNew patients
Freedom First Psychological Services, PLLC CurrentSince Apr 30, 2023 Accepting new patients
Romero Oncology, PLLC CurrentSince Apr 30, 2023 Accepting new patients
Advanced Therapy, P.L.L.C. Past Accepting new patients

Locations

4 Avis Dr
Ste 101
Latham, NY 12110
Phone (518) 560-4277

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1475107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783641600000",
    "number": "1902355159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1721 CENTRAL AVE",
            "city": "COLONIE",
            "state": "NY",
            "postal_code": "122054799",
            "telephone_number": "518-903-9671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 AVIS DR STE 101",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121102650",
            "telephone_number": "518-560-4277",
            "fax_number": "518-662-4277"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1721 Central Ave",
            "address_purpose": "LOCATION",
            "city": "Colonie",
            "state": "NY",
            "postal_code": "122054799",
            "country_code": "US",
            "telephone_number": "518-903-9671",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WATERMAN",
        "first_name": "JESSICA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-29",
        "last_updated": "2026-07-10",
        "certification_date": "2026-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": "090268",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Latham, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2026; 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.