Provider Demographics
NPI:1922564574
Name:WATT, STEPHANIE ELAINE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ELAINE
Last Name:WATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2885 CONCORD BLVD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94519-2608
Mailing Address - Country:US
Mailing Address - Phone:925-777-1133
Mailing Address - Fax:
Practice Address - Street 1:2885 CONCORD BLVD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94519-2608
Practice Address - Country:US
Practice Address - Phone:925-777-1133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health