MEDICARE: DR. MARY ANN WATSON PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	420	CO

General Provider Information

NPI Number	:	1639236201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY ANN WATSON PHD

Provider Business Mailing Address
First Line	:	1490 LAFAYETTE STREET
Second Line	:	SUITE 105A
City	:	DENVER
State	:	CO
Zip	:	80218-2391
Country	:	US
Telephone Number	:	303-322-9334
Fax Number	:	303-832-0044

Provider Business Practice Location Address
First Line	:	1490 LAFAYETTE STREET
Second Line	:	SUITE 105A
City	:	DENVER
State	:	CO
Zip	:	80218-2391
Country	:	US
Telephone Number	:	303-322-9334
Fax Number	:	303-832-0044

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	04/02/2013

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