Healthcare Provider Details

I. General information

NPI: 1437268638
Provider Name (Legal Business Name): LISA WATT PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2927 N 7TH AVE
PHOENIX AZ
85013-4102
US

IV. Provider business mailing address

3200 N CENTRAL AVE SUITE 900
PHOENIX AZ
85012-2425
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-5864
  • Fax: 602-406-3030
Mailing address:
  • Phone: 602-406-3729
  • Fax: 602-798-9412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3696
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: