Provider Demographics
NPI:1003816992
Name:WATT, DOUGLAS F (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:F
Last Name:WATT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 CHARLOTTE AVE
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03064-1551
Mailing Address - Country:US
Mailing Address - Phone:508-740-0391
Mailing Address - Fax:508-657-8605
Practice Address - Street 1:24 CHARLOTTE AVE
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03064-1551
Practice Address - Country:US
Practice Address - Phone:508-740-0391
Practice Address - Fax:508-657-8605
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4125103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW04056Medicare ID - Type UnspecifiedBC-BS & MEDICARE NUMBER