Provider Demographics
NPI:1851544662
Name:WATSON, LEIGH DICKERSON (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEIGH
Middle Name:DICKERSON
Last Name:WATSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SCENIC WAY
Mailing Address - Street 2:APT. 216
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-3161
Mailing Address - Country:US
Mailing Address - Phone:650-380-9843
Mailing Address - Fax:
Practice Address - Street 1:1220 UNIVERSITY DR
Practice Address - Street 2:SUITE 103
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4262
Practice Address - Country:US
Practice Address - Phone:650-380-9843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21722103TC0700X
NC3322103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical