Provider Demographics
NPI:1619528080
Name:WATSON, LORI ANN (BCBA)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:WATSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 BRICKYARD COVE RD
Mailing Address - Street 2:
Mailing Address - City:HARPSWELL
Mailing Address - State:ME
Mailing Address - Zip Code:04079-4100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 MOHAWK DR
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3757
Practice Address - Country:US
Practice Address - Phone:978-710-6837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty