Provider Demographics
NPI:1982837993
Name:WATSON, DYANE KAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:DYANE
Middle Name:KAY
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 1:426 OSTROM AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2938
Mailing Address - Country:US
Mailing Address - Phone:315-443-6170
Mailing Address - Fax:
Practice Address - Street 1:426 OSTROM AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2938
Practice Address - Country:US
Practice Address - Phone:315-443-6170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006398106H00000X
NYP66808106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist