Provider Demographics
NPI:1982474243
Name:WATT, LEANNE E (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEANNE
Middle Name:E
Last Name:WATT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:766 E COLORADO BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-5421
Mailing Address - Country:US
Mailing Address - Phone:626-484-7444
Mailing Address - Fax:
Practice Address - Street 1:766 E COLORADO BLVD STE 203
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-5421
Practice Address - Country:US
Practice Address - Phone:626-484-7444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13321103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical