Provider Demographics
NPI:1306320973
Name:WATANABE, SATOKO (LICSW)
Entity type:Individual
Prefix:MRS
First Name:SATOKO
Middle Name:
Last Name:WATANABE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:WATANABE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:99 MASSACHUSETTS AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-8600
Mailing Address - Country:US
Mailing Address - Phone:781-296-1800
Mailing Address - Fax:781-648-4315
Practice Address - Street 1:99 MASSACHUSETTS AVE STE 6
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-8600
Practice Address - Country:US
Practice Address - Phone:781-296-1800
Practice Address - Fax:781-648-4315
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1182391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical