Provider Demographics
NPI:1871676098
Name:WATT, DEANNA (MFT)
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:
Last Name:WATT
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MRS
Other - First Name:DEE
Other - Middle Name:
Other - Last Name:WATT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1815 FOURTH STREET
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404
Mailing Address - Country:US
Mailing Address - Phone:707-546-2232
Mailing Address - Fax:707-823-3353
Practice Address - Street 1:1815 FOURTH STREET
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404
Practice Address - Country:US
Practice Address - Phone:707-546-2232
Practice Address - Fax:707-823-3353
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC13654106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist