Provider Demographics
NPI:1689953010
Name:WATTS, LISA BROOK (MSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:BROOK
Last Name:WATTS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 N 2ND ST STE 301
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4435
Mailing Address - Country:US
Mailing Address - Phone:772-595-3773
Mailing Address - Fax:
Practice Address - Street 1:121 N 2ND ST STE 301
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4435
Practice Address - Country:US
Practice Address - Phone:772-595-3773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker