Provider Demographics
NPI:1972151579
Name:WATSON, LAWRENCE PETER JR (CRPA)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:PETER
Last Name:WATSON
Suffix:JR
Gender:M
Credentials:CRPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12202-2011
Mailing Address - Country:US
Mailing Address - Phone:518-447-3005
Mailing Address - Fax:518-447-2523
Practice Address - Street 1:175 GREEN ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12202-2011
Practice Address - Country:US
Practice Address - Phone:518-447-2067
Practice Address - Fax:518-447-2523
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3696101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01420800Medicaid