Provider Demographics
NPI:1386022762
Name:WATTS, CAROL (LISW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:WATTS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 CENTRAL AVE SE
Mailing Address - Street 2:SUITE 221
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3656
Mailing Address - Country:US
Mailing Address - Phone:505-345-9288
Mailing Address - Fax:
Practice Address - Street 1:600 CENTRAL AVE SE
Practice Address - Street 2:SUITE 221
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3656
Practice Address - Country:US
Practice Address - Phone:505-345-9288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-23691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical