Provider Demographics
NPI:1063638518
Name:WATTS, DAVID L (LISW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:L
Last Name:WATTS
Suffix:
Gender:M
Credentials:LISW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 E 213TH ST
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-1065
Mailing Address - Country:US
Mailing Address - Phone:440-409-8690
Mailing Address - Fax:
Practice Address - Street 1:1305 W 80TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-6204
Practice Address - Country:US
Practice Address - Phone:440-409-8690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 86011041C0700X
OHI-11012881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH057830Medicare PIN
OHR72337Medicare UPIN