Healthcare Provider Details

I. General information

NPI: 1164766176
Provider Name (Legal Business Name): LINDA WATT PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 SAINT MARGARETS ST UNIT 1
BUZZARDS BAY MA
02532-3269
US

IV. Provider business mailing address

9 SAINT MARGARETS ST UNIT 1
BUZZARDS BAY MA
02532-3269
US

V. Phone/Fax

Practice location:
  • Phone: 508-326-4371
  • Fax:
Mailing address:
  • Phone: 508-326-4371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number8821
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: