Healthcare Provider Details

I. General information

NPI: 1447306469
Provider Name (Legal Business Name): CAROLINE L WATTS EDD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

IV. Provider business mailing address

41 CURTIS ST
WALTHAM MA
02453-3444
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-7450
  • Fax: 617-730-0271
Mailing address:
  • Phone: 781-209-2239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6846
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: