Provider Demographics
NPI:1235390352
Name:WATSON, JENNIFER M (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:M
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 1:5341 SW 91ST TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-8108
Mailing Address - Country:US
Mailing Address - Phone:352-256-4904
Mailing Address - Fax:352-374-2166
Practice Address - Street 1:5341 SW 91ST TER
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-8108
Practice Address - Country:US
Practice Address - Phone:352-256-4904
Practice Address - Fax:352-374-2166
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PY7111103TB0200X, 103TH0004X
FLPY7111103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth