Healthcare Provider Details

I. General information

NPI: 1679235428
Provider Name (Legal Business Name): KAYLYN L WATTERSON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. KATIE L WATTERSON

II. Dates (important events)

Enumeration Date: 10/08/2021
Last Update Date: 10/08/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CLARA BARTON DR # MC-164
ALBANY NY
12208-3472
US

IV. Provider business mailing address

2 CLARA BARTON DR # MC-164
ALBANY NY
12208-3472
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-5511
  • Fax: 518-262-6111
Mailing address:
  • Phone: 219-512-0924
  • Fax: 518-262-6111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: