Provider Demographics
NPI:1659432359
Name:WATSON, PATRICIA M (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:M
Last Name:WATSON
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5118
Mailing Address - Country:US
Mailing Address - Phone:410-583-2222
Mailing Address - Fax:410-583-2377
Practice Address - Street 1:110 E PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5118
Practice Address - Country:US
Practice Address - Phone:410-583-2222
Practice Address - Fax:410-583-2377
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KQ69LQ23Medicare ID - Type Unspecified