Provider Demographics
NPI:1336566975
Name:THE WATSON INSTITUTE
Entity Type:Organization
Organization Name:THE WATSON INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYLAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:412-365-3815
Mailing Address - Street 1:255 S NEGLEY AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3522
Mailing Address - Country:US
Mailing Address - Phone:412-365-3815
Mailing Address - Fax:412-365-6775
Practice Address - Street 1:255 S NEGLEY AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3522
Practice Address - Country:US
Practice Address - Phone:412-365-3815
Practice Address - Fax:412-365-6775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA414590261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1487469OtherHIGHMARK BLUE CROSS BLUE SHIELD
PA1007525810003Medicaid