Provider Demographics
NPI:1831515675
Name:WATSON, ROY III (MED, BCBA, BSC)
Entity type:Individual
Prefix:MR
First Name:ROY
Middle Name:
Last Name:WATSON
Suffix:III
Gender:M
Credentials:MED, BCBA, BSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 HARVEST GLEN DR
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-1768
Mailing Address - Country:US
Mailing Address - Phone:215-256-9889
Mailing Address - Fax:
Practice Address - Street 1:111 HARVEST GLEN DR
Practice Address - Street 2:
Practice Address - City:HARLEYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19438-1768
Practice Address - Country:US
Practice Address - Phone:215-256-9889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH001233103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst