MEDICARE: WENDY L WATTS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	0667711	NY
2	1041C0700X	Clinical Social Worker	65989	TX

General Provider Information

NPI Number	:	1588767701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY L WATTS LCSW

Provider Business Mailing Address
First Line	:	1121 BEACHVIEW ST APT 2213
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75218-3613
Country	:	US
Telephone Number	:	917-209-5602
Fax Number	:	845-876-3276

Provider Business Practice Location Address
First Line	:	7272 WURZBACH RD STE 706
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-4803
Country	:	US
Telephone Number	:	210-615-3483
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	01/12/2023

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