Provider Demographics
NPI:1477671576
Name:WATSON, MICHAEL WESLEY (MHS, MFT, CRAS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:WESLEY
Last Name:WATSON
Suffix:
Gender:M
Credentials:MHS, MFT, CRAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 E SOMERDALE RD
Mailing Address - Street 2:
Mailing Address - City:SOMERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:08083-1108
Mailing Address - Country:US
Mailing Address - Phone:856-782-1553
Mailing Address - Fax:856-782-1030
Practice Address - Street 1:312 E SOMERDALE RD
Practice Address - Street 2:
Practice Address - City:SOMERDALE
Practice Address - State:NJ
Practice Address - Zip Code:08083-1108
Practice Address - Country:US
Practice Address - Phone:856-782-1553
Practice Address - Fax:856-782-1030
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0019674Medicaid