Provider Demographics
NPI:1215990015
Name:MOTT, DONALD W (LCSW-R)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:W
Last Name:MOTT
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 MULLIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-3618
Mailing Address - Country:US
Mailing Address - Phone:315-408-7238
Mailing Address - Fax:
Practice Address - Street 1:482 BLACK RIVER PKWY
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-2416
Practice Address - Country:US
Practice Address - Phone:315-782-1777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR080284-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical