Provider Demographics
NPI:1639500028
Name:WATSON, LORI L (MSW LSW)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:L
Last Name:WATSON
Suffix:
Gender:F
Credentials:MSW LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3102 ABERDEEN LANE
Mailing Address - Street 2:
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012
Mailing Address - Country:US
Mailing Address - Phone:856-232-8062
Mailing Address - Fax:
Practice Address - Street 1:3102 ABERDEEN LANE
Practice Address - Street 2:
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012
Practice Address - Country:US
Practice Address - Phone:856-232-8062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL04658800104100000X
PASW010033L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker