Provider Demographics
NPI:1053320200
Name:WATSON, PAMELA GAIL (LICSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:GAIL
Last Name:WATSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 RIVER HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-3811
Mailing Address - Country:US
Mailing Address - Phone:401-789-2664
Mailing Address - Fax:
Practice Address - Street 1:61 RIVER HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-3811
Practice Address - Country:US
Practice Address - Phone:401-789-2664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW009511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIISW00951OtherSOCIAL WORK LICENCE