Provider Demographics
NPI:1740685312
Name:WATTS, LINDA TINA (LMSW)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:TINA
Last Name:WATTS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 TEMPESTA TER
Mailing Address - Street 2:
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-6934
Mailing Address - Country:US
Mailing Address - Phone:347-256-6242
Mailing Address - Fax:973-403-9958
Practice Address - Street 1:96 5TH AVE APT 1K
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7604
Practice Address - Country:US
Practice Address - Phone:347-256-6242
Practice Address - Fax:973-403-9958
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-25
Last Update Date:2014-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054971-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker