Healthcare Provider Details

I. General information

NPI: 1952707366
Provider Name (Legal Business Name): KATHERINE WATTS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2014
Last Update Date: 03/28/2021
Certification Date: 03/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 BRAGDON LN STE 1
KENNEBUNK ME
04043-7262
US

IV. Provider business mailing address

50 MOODY ST SWEETSER
SACO ME
04072-1536
US

V. Phone/Fax

Practice location:
  • Phone: 207-337-8255
  • Fax:
Mailing address:
  • Phone: 800-434-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC16432
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: