Provider Demographics
NPI:1043761703
Name:WATSON, DANIEL BRYANT
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:BRYANT
Last Name:WATSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 W COTTAGE ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02125-2900
Mailing Address - Country:US
Mailing Address - Phone:857-492-5188
Mailing Address - Fax:
Practice Address - Street 1:87 W COTTAGE ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02125-2900
Practice Address - Country:US
Practice Address - Phone:857-492-5188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health