Individual
TIMOTHY W WATKINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
18 EAGLE ST, SANTO DOMINGO PUEBLO, NM 87052-8705
(505) 465-2733
Mailing address
PO BOX 130, SANTO DOMINGO PUEBLO, NM 87052-0130
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
M-07371
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
B8961
—
NM
Enumeration date
09/24/2010
Last updated
01/17/2019
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