Healthcare Provider Details

I. General information

NPI: 1952428427
Provider Name (Legal Business Name): MARY E WATTS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 N 6TH ST 140
FRESNO CA
93710-7514
US

IV. Provider business mailing address

1550 E NILES AVE
FRESNO CA
93720-2300
US

V. Phone/Fax

Practice location:
  • Phone: 559-246-0210
  • Fax: 559-227-6149
Mailing address:
  • Phone: 559-246-0210
  • Fax: 559-227-6149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS19627
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: