Provider Demographics
NPI:1063782407
Name:WATTS, ROBIN LYNETTE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:LYNETTE
Last Name:WATTS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:ROBIN
Other - Middle Name:LYNETTE
Other - Last Name:WATTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:62 CLUBHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:TUXEDO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:10987
Mailing Address - Country:US
Mailing Address - Phone:845-351-5619
Mailing Address - Fax:
Practice Address - Street 1:62 CLUBHOUSE RD
Practice Address - Street 2:
Practice Address - City:TUXEDO PARK
Practice Address - State:NY
Practice Address - Zip Code:10987
Practice Address - Country:US
Practice Address - Phone:845-351-5619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029283-11041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool