Provider Demographics
NPI:1467883090
Name:WATSON, CYNTHIA III (LSW)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:
Last Name:WATSON
Suffix:III
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2580 SHILOH SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:TROTWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45426-2151
Mailing Address - Country:US
Mailing Address - Phone:937-429-2474
Mailing Address - Fax:937-529-4538
Practice Address - Street 1:2580 SHILOH SPRINGS RD
Practice Address - Street 2:SUITE B
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45426-2151
Practice Address - Country:US
Practice Address - Phone:937-429-2474
Practice Address - Fax:937-529-4538
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-08
Last Update Date:2013-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS0030309104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker