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General NPI Number Information
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NPI Number | 1790438430
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Entity Type | Organization
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Legal Business Name | THE WATCH WELLNESS GROUP, INC.
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Dates
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Enumeration Date | 02/02/2022
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Last Update Date | 02/15/2022
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Provider Practice Location Address
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Address Line | 104 MOODY ST
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City | LUDLOW
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State | MA
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Zip | 01056-1273
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Country | US
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Telephone | 413-885-0464
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Fax |
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Provider Business Mailing Address
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Address Line | 31 NASH HILL RD
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City | LUDLOW
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State | MA
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Zip | 01056-1006
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Country | US
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Telephone | 413-885-0464
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | LISA KNOWLES-WARREN
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Credential | LMHC
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Telephone | 413-330-3342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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