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NPI Code Detail

MEDICARE: LISA WATT PHD

MEDICARE: LISA WATT PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist3696AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1437268638
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA WATT PHD
Provider Business Mailing Address
First Line : 3200 N CENTRAL AVE
Second Line : SUITE 900
City : PHOENIX
State : AZ
Zip : 85012-2425
Country : US
Telephone Number : 602-406-3729
Fax Number : 602-798-9412
Provider Business Practice Location Address
First Line : 2927 N 7TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85013-4102
Country : US
Telephone Number : 602-406-5864
Fax Number : 602-406-3030
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 07/09/2007

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