Provider Demographics
NPI:1174502215
Name:WATSON, SANDRA STEINER (PHD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:STEINER
Last Name:WATSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E OCEAN BLVD
Mailing Address - Street 2:F253
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2471
Mailing Address - Country:US
Mailing Address - Phone:772-287-7471
Mailing Address - Fax:772-287-7471
Practice Address - Street 1:900 E OCEAN BLVD
Practice Address - Street 2:F253
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2471
Practice Address - Country:US
Practice Address - Phone:772-287-7471
Practice Address - Fax:772-287-7471
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0003325103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75238Medicare ID - Type UnspecifiedPROVIDER NUMBER