Provider Demographics
NPI:1871943019
Name:MCWATERS, JENNIFER (PSYD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MCWATERS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:STUMPF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5055 N HARBOR DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-2302
Mailing Address - Country:US
Mailing Address - Phone:619-275-2286
Mailing Address - Fax:
Practice Address - Street 1:5055 N HARBOR DR
Practice Address - Street 2:SUITE 320
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-2302
Practice Address - Country:US
Practice Address - Phone:619-275-2286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-19
Last Update Date:2016-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26521103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical