Provider Demographics
NPI:1316101215
Name:WATTS, LEE GERALD (LCSW)
Entity type:Individual
Prefix:MR
First Name:LEE
Middle Name:GERALD
Last Name:WATTS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1515 TAMIAMI TRL S
Mailing Address - Street 2:SUITE 5
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-5557
Mailing Address - Country:US
Mailing Address - Phone:941-445-1413
Mailing Address - Fax:941-493-4740
Practice Address - Street 1:1515 TAMIAMI TRL S
Practice Address - Street 2:SUITE 5
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-5557
Practice Address - Country:US
Practice Address - Phone:941-445-1413
Practice Address - Fax:941-493-4740
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1107871041C0700X
FLSW99191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical