Provider Demographics
NPI:1376708388
Name:WATKINS-CLAY, MARY MONICA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:MONICA
Last Name:WATKINS-CLAY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:MONICA
Other - Last Name:WATKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:4970 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-6802
Mailing Address - Country:US
Mailing Address - Phone:850-718-5620
Mailing Address - Fax:850-718-5670
Practice Address - Street 1:4970 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-6802
Practice Address - Country:US
Practice Address - Phone:850-718-5620
Practice Address - Fax:850-718-5670
Is Sole Proprietor?:No
Enumeration Date:2008-07-20
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TF0200X
FLPY7150103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic