Provider Demographics
NPI:1093197535
Name:WATSON, CHANTE (MS)
Entity Type:Individual
Prefix:
First Name:CHANTE
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:838 E 49TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-5814
Mailing Address - Country:US
Mailing Address - Phone:917-405-4558
Mailing Address - Fax:
Practice Address - Street 1:838 E 49TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-5814
Practice Address - Country:US
Practice Address - Phone:917-405-4558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-21
Last Update Date:2015-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist