Provider Demographics
NPI:1669014478
Name:WATSON, MARCO BERNARD (LCSW)
Entity Type:Individual
Prefix:
First Name:MARCO
Middle Name:BERNARD
Last Name:WATSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11111 HUDSON HILLS LN
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-3211
Mailing Address - Country:US
Mailing Address - Phone:813-775-8987
Mailing Address - Fax:
Practice Address - Street 1:4100 W. KENNEDY BLVD
Practice Address - Street 2:STE. 326
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3360
Practice Address - Country:US
Practice Address - Phone:813-775-8987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-14
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW16728101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health