Provider Demographics
NPI:1720717986
Name:WATSON, NICOLAS STONE
Entity Type:Individual
Prefix:
First Name:NICOLAS
Middle Name:STONE
Last Name:WATSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5650 EL CAMINO REAL STE 125
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-7146
Mailing Address - Country:US
Mailing Address - Phone:714-222-0331
Mailing Address - Fax:
Practice Address - Street 1:5650 EL CAMINO REAL STE 125
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-7146
Practice Address - Country:US
Practice Address - Phone:714-222-0331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-05
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA143113106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist