Provider Demographics
NPI:1396095543
Name:WATSON, LISA MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:WATSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:16004 CROSSBAY BLVD # 163
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-3407
Mailing Address - Country:US
Mailing Address - Phone:858-898-1855
Mailing Address - Fax:858-898-1890
Practice Address - Street 1:163 BEACH 96TH ST # 3A
Practice Address - Street 2:
Practice Address - City:ROCKAWAY BEACH
Practice Address - State:NY
Practice Address - Zip Code:11693-1304
Practice Address - Country:US
Practice Address - Phone:858-898-1855
Practice Address - Fax:858-898-1890
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25210103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical