Provider Demographics
NPI:1639236201
Name:WATSON, MARY ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANN
Last Name:WATSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1490 LAFAYETTE STREET
Mailing Address - Street 2:SUITE 105A
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-2391
Mailing Address - Country:US
Mailing Address - Phone:303-322-9334
Mailing Address - Fax:303-832-0044
Practice Address - Street 1:1490 LAFAYETTE STREET
Practice Address - Street 2:SUITE 105A
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-2391
Practice Address - Country:US
Practice Address - Phone:303-322-9334
Practice Address - Fax:303-832-0044
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO420103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
C94376Medicare ID - Type Unspecified