Provider Demographics
NPI:1376522581
Name:WATSON, BARBARA M (PHD)
Entity Type:Individual
Prefix:
First Name:BARBARA
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 1:6 FRANKLIN PLAZA
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148
Mailing Address - Country:US
Mailing Address - Phone:215-587-3122
Mailing Address - Fax:215-587-9405
Practice Address - Street 1:6 FRANKLIN PLAZA
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148
Practice Address - Country:US
Practice Address - Phone:215-587-3122
Practice Address - Fax:215-587-9405
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004374L103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA151010MMVMedicare PIN
R06343Medicare UPIN