Provider Demographics
NPI:1538461074
Name:WATSON, RITA J (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:RITA
Middle Name:J
Last Name:WATSON
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 1:1626 6TH AVE N
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-1720
Mailing Address - Country:US
Mailing Address - Phone:406-208-8961
Mailing Address - Fax:406-727-3799
Practice Address - Street 1:1626 6TH AVE N
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-1720
Practice Address - Country:US
Practice Address - Phone:406-208-8961
Practice Address - Fax:406-727-3799
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000071158OtherBLUE CROSS-SHIELD OF MONTANA
MTM011001833Medicare PIN