Provider Demographics
NPI:1114362605
Name:WATSON, KATHY ANGELA
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:ANGELA
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2046 ALLEN AVE
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-3424
Mailing Address - Country:US
Mailing Address - Phone:626-396-5920
Mailing Address - Fax:
Practice Address - Street 1:2046 ALLEN AVE
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-3424
Practice Address - Country:US
Practice Address - Phone:626-396-5920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)