Provider Demographics
NPI:1750459830
Name:WATTIMO, JOAN K (MS)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:K
Last Name:WATTIMO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
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Mailing Address - Street 1:1010 MASSACHUSETTS AVENUE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118
Mailing Address - Country:US
Mailing Address - Phone:617-534-4212
Mailing Address - Fax:617-534-4221
Practice Address - Street 1:723 MASSACHUSETTS AVENUE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-534-4212
Practice Address - Fax:617-534-4221
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)