Provider Demographics
NPI:1295132918
Name:WATSON, DAMIAN WESLEY (LCSW)
Entity type:Individual
Prefix:MR
First Name:DAMIAN
Middle Name:WESLEY
Last Name:WATSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12041 TUSCANY BAY DR
Mailing Address - Street 2:APT. 101
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1339
Mailing Address - Country:US
Mailing Address - Phone:850-889-6476
Mailing Address - Fax:850-889-6476
Practice Address - Street 1:12041 TUSCANY BAY DR
Practice Address - Street 2:APT. 101
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1339
Practice Address - Country:US
Practice Address - Phone:850-889-6476
Practice Address - Fax:850-889-6476
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW120811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical