Provider Demographics
NPI:1386457133
Name:WATSON, LORI AILEEN
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:AILEEN
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-6898
Mailing Address - Country:US
Mailing Address - Phone:774-444-5269
Mailing Address - Fax:
Practice Address - Street 1:19 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-6898
Practice Address - Country:US
Practice Address - Phone:774-444-5269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health