Provider Demographics
NPI:1508899410
Name:WATSON, KIMBERLY L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:L
Last Name:WATSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NEW SALEM RD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-8936
Mailing Address - Country:US
Mailing Address - Phone:724-437-0729
Mailing Address - Fax:724-437-2763
Practice Address - Street 1:100 NEW SALEM RD
Practice Address - Street 2:SUITE 116
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-8936
Practice Address - Country:US
Practice Address - Phone:724-437-0729
Practice Address - Fax:724-437-2763
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW-0149041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IP325280OtherMAGELLAN
7220315OtherAETNA
00780561OtherHIGHMARK
087883EPMMedicare ID - Type Unspecified
Q35245Medicare UPIN