Provider Demographics
NPI:1063443414
Name:WATSON, ALEASE T (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:ALEASE
Middle Name:T
Last Name:WATSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 BIRD AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14213-1109
Mailing Address - Country:US
Mailing Address - Phone:716-883-9209
Mailing Address - Fax:
Practice Address - Street 1:JEWISH FAMILY SERVICE OF BUFFALO & ERIE COUNTY
Practice Address - Street 2:70 BARKER ST
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-2013
Practice Address - Country:US
Practice Address - Phone:716-883-1914
Practice Address - Fax:716-883-7637
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0693161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00688211Medicaid