Provider Demographics
NPI:1760191498
Name:WATSON, STEPHEN DANIEL (BCBA)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:DANIEL
Last Name:WATSON
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3060 SUNRISE CIR
Mailing Address - Street 2:
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-3721
Mailing Address - Country:US
Mailing Address - Phone:774-331-7074
Mailing Address - Fax:
Practice Address - Street 1:3060 SUNRISE CIR
Practice Address - Street 2:
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-3721
Practice Address - Country:US
Practice Address - Phone:774-331-7074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-22-61586103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst