Healthcare Provider Details

I. General information

NPI: 1194032425
Provider Name (Legal Business Name): FATIMA A WATT PSY.D., MPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 DAN RD STE 125
CANTON MA
02021-2852
US

IV. Provider business mailing address

16 NEWTON ST
MANSFIELD MA
02048-1912
US

V. Phone/Fax

Practice location:
  • Phone: 508-261-4675
  • Fax:
Mailing address:
  • Phone: 508-261-4675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number9589
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: