Provider Demographics
NPI:1922187509
Name:WATT, KATHLEEN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:
Last Name:WATT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ANGELICA CT
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-1230
Mailing Address - Country:US
Mailing Address - Phone:315-638-0121
Mailing Address - Fax:
Practice Address - Street 1:530 CEDAR ST
Practice Address - Street 2:OCDMH OUTPATIENT TREATMENT PROGRAM
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2302
Practice Address - Country:US
Practice Address - Phone:315-435-7707
Practice Address - Fax:315-435-7710
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR029282-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical