Provider Demographics
NPI:1790438430
Name:THE WATCH WELLNESS GROUP, INC.
Entity Type:Organization
Organization Name:THE WATCH WELLNESS GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOWLES-WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:413-330-3342
Mailing Address - Street 1:31 NASH HILL RD
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-1006
Mailing Address - Country:US
Mailing Address - Phone:413-885-0464
Mailing Address - Fax:
Practice Address - Street 1:104 MOODY ST
Practice Address - Street 2:
Practice Address - City:LUDLOW
Practice Address - State:MA
Practice Address - Zip Code:01056-1273
Practice Address - Country:US
Practice Address - Phone:413-885-0464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-02
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1457564692Medicaid