Provider Demographics
NPI:1932310489
Name:WATT, DAVID (PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:WATT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39155 LIBERTY ST
Mailing Address - Street 2:SUITE E500
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1513
Mailing Address - Country:US
Mailing Address - Phone:510-574-2136
Mailing Address - Fax:510-574-2105
Practice Address - Street 1:39155 LIBERTY ST
Practice Address - Street 2:SUITE E500
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1513
Practice Address - Country:US
Practice Address - Phone:510-574-2136
Practice Address - Fax:510-574-2105
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17366103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical