Provider Demographics
NPI:1043899883
Name:WATSON, TONI LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:LYNN
Last Name:WATSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23380 N 61ST DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-5748
Mailing Address - Country:US
Mailing Address - Phone:602-503-0710
Mailing Address - Fax:602-429-8602
Practice Address - Street 1:14040 N CAVE CREEK RD STE 205
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-6179
Practice Address - Country:US
Practice Address - Phone:503-503-0710
Practice Address - Fax:602-429-8602
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLCSW-19439OtherSTATE OF AZ BOARD OF BEHAVIORAL HEALTH EXAMINERS