Provider Demographics
NPI:1073642476
Name:WATSON, MADELAINE JOHANNE (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:MADELAINE
Middle Name:JOHANNE
Last Name:WATSON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 SHORELAKE DR APT B
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-1465
Mailing Address - Country:US
Mailing Address - Phone:336-286-2244
Mailing Address - Fax:336-545-9970
Practice Address - Street 1:109 SHORELAKE DR APT B
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-1465
Practice Address - Country:US
Practice Address - Phone:336-286-2244
Practice Address - Fax:336-545-9970
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0036801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical