Provider Demographics
NPI:1013296458
Name:WATTON, SHERON MARIE (MFT)
Entity Type:Individual
Prefix:MS
First Name:SHERON
Middle Name:MARIE
Last Name:WATTON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3481 STANCREST DR
Mailing Address - Street 2:#104
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1353
Mailing Address - Country:US
Mailing Address - Phone:818-471-9040
Mailing Address - Fax:
Practice Address - Street 1:200 E DEL MAR BLVD
Practice Address - Street 2:#208
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2544
Practice Address - Country:US
Practice Address - Phone:626-578-7111
Practice Address - Fax:626-578-7161
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 48925106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist