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General NPI Number Information
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NPI Number | 1356871305
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Entity Type | Individual
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Provider Name | JUDITH WATTA LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/13/2017
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Last Update Date | 07/17/2024
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Provider Practice Location Address
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Address Line | 21 N BROAD ST STE E # 10104
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City | LURAY
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State | VA
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Zip | 22835-1162
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Country | US
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Telephone | 571-449-7837
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Fax | 571-449-7837
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Provider Business Mailing Address
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Address Line | PO BOX 806054
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-6054
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Country | US
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Telephone | 571-449-7837
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Fax | 571-449-7837
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904009896
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License Number State |
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