Healthcare Provider Details

I. General information

NPI: 1568451805
Provider Name (Legal Business Name): BRUCE ROBERT WATSON MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1687 ERRINGER RD STE. 202B
SIMI VALLEY CA
93065-6508
US

IV. Provider business mailing address

6144 FREMONT CIRCLE
CAMARILLO CA
93012
US

V. Phone/Fax

Practice location:
  • Phone: 805-526-8534
  • Fax:
Mailing address:
  • Phone: 805-373-0233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 5676
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: