Provider Demographics
NPI:1700853330
Name:WATSON, ROGER A (MFT)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:A
Last Name:WATSON
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 N IRWIN ST
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-3838
Mailing Address - Country:US
Mailing Address - Phone:559-584-2819
Mailing Address - Fax:559-584-2820
Practice Address - Street 1:808 N IRWIN ST
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-3838
Practice Address - Country:US
Practice Address - Phone:559-584-2819
Practice Address - Fax:559-584-2820
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist