Provider Demographics
NPI:1811071681
Name:WATSON, RICHARD L (LCSW)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:WATSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 WATER ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-4615
Mailing Address - Country:US
Mailing Address - Phone:207-621-2304
Mailing Address - Fax:207-621-2471
Practice Address - Street 1:271 WATER ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-4615
Practice Address - Country:US
Practice Address - Phone:207-621-2304
Practice Address - Fax:207-621-2471
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC16781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1811071681Medicaid
ME431728899Medicaid
ME1811071681Medicaid