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NPI Code Detail

MEDICARE: SCARLETTE ALLYN WATERMAN BA, LSAA

MEDICARE: SCARLETTE ALLYN WATERMAN BA, LSAA
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
1101YA0400XAddiction (Substance Use Disorder) CounselorCSA0183801NM

General Provider Information

NPI Number : 1629570585
Entity Type Code : Individual
Provider Name (Legal Business Name) : SCARLETTE ALLYN WATERMAN BA, LSAA
Provider Business Mailing Address
First Line : 1227 N RAILROAD AVE STE C
Second Line :
City : ESPANOLA
State : NM
Zip : 87532-3159
Country : US
Telephone Number : 505-747-8187
Fax Number : 505-747-8306
Provider Business Practice Location Address
First Line : 1227 N RAILROAD AVE STE C
Second Line :
City : ESPANOLA
State : NM
Zip : 87532-3159
Country : US
Telephone Number : 505-747-8187
Fax Number : 505-747-8306
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2018
Last Update Date : 03/06/2018

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