Provider Demographics
NPI:1437266251
Name:WATT, BARBARA JOYCE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:JOYCE
Last Name:WATT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S 11TH AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4880
Mailing Address - Country:US
Mailing Address - Phone:208-232-7862
Mailing Address - Fax:208-232-2408
Practice Address - Street 1:500 S 11TH AVE STE 400
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201
Practice Address - Country:US
Practice Address - Phone:208-232-7862
Practice Address - Fax:208-232-2408
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1041C0700X
WALW602711891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1437266251Medicaid
MT0MT0705363OtherBLUE CROSS-SHIELD OF MONTANA
WA1437266251Medicare UPIN
WA1437266251Medicare NSC
MT0MT0705363OtherBLUE CROSS-SHIELD OF MONTANA
MTM011009064Medicare PIN
WA1437266251Medicare Oscar/Certification