Provider Demographics
NPI:1669723623
Name:WATSON, DEBORAH (PHD, LMHC)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:PHD, LMHC
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LMHC
Mailing Address - Street 1:8362 PINES BLVD
Mailing Address - Street 2:#338
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6600
Mailing Address - Country:US
Mailing Address - Phone:954-446-5032
Mailing Address - Fax:
Practice Address - Street 1:3440 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 415
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6927
Practice Address - Country:US
Practice Address - Phone:954-446-5032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-30
Last Update Date:2013-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10959101YA0400X
FL10959101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)