Provider Demographics
NPI:1053619403
Name:WATTS, DIANA P (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:P
Last Name:WATTS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2287 PHILIPPINE DRIVE
Mailing Address - Street 2:APT 49
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-2821
Mailing Address - Country:US
Mailing Address - Phone:813-253-8974
Mailing Address - Fax:
Practice Address - Street 1:2287 PHILIPPINE DRIVE
Practice Address - Street 2:APT 49
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-2821
Practice Address - Country:US
Practice Address - Phone:813-253-8974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical