Malissa Watterson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904016139 Issued in VA

Practice address

3 Boars Head LN Ste C6
Charlottesville, VA 22903-4604

Phone

(434) 566-0113

NPI assigned

Dec 1, 2023

Last updated

Dec 1, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Feb 7, 2024 through Feb 7, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Rob Young, PSYD, BCB

  dba Charlottesville Center for Cognitive Behavioral Therapy

  • Clinical Psychologist
  • Charlottesville, VA
  • NPI 1487197471
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1701388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701388800000",
    "number": "1174399950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6795 DARTMOUTH AVE",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232262921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 BOARS HEAD LN STE C6",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229034604",
            "telephone_number": "434-566-0113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATTERSON",
        "first_name": "MALISSA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-12-01",
        "last_updated": "2023-12-01",
        "certification_date": "2023-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904016139",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Suzanne Waters, NP
• Chloe Hodson Watkins
• Clare Watson
• John Thomas Watson, M.D.
• Kathleen Doyle Watt, LCSW
• Cedona Watts, PHARM.D.
• Emily Wax, RD, CNSC
• Way Forward Group LLC
• Denise A. Way, M.D.
• Sydney Wayand

• Clinical Social Worker in Charlottesville, VA
• Providers in Charlottesville, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.