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General NPI Number Information
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NPI Number | 1508345778
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Entity Type | Individual
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Provider Name | TARA MARIE WATKINS LICSW
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Gender | Female
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Dates
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Enumeration Date | 08/08/2018
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Last Update Date | 05/04/2022
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Provider Practice Location Address
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Address Line | 1165 N MAIN ST
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City | PROVIDENCE
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State | RI
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Zip | 02904-5740
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Country | US
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Telephone | 401-527-7772
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Fax |
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Provider Business Mailing Address
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Address Line | 195 SELMA ST
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City | CRANSTON
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State | RI
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Zip | 02920-6207
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Country | US
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Telephone | 401-954-6750
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Fax |
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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 | 114802
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ISW02457
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License Number State | RI
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