Healthcare Provider Details

I. General information

NPI: 1821952102
Provider Name (Legal Business Name): YVONNE WATZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 W 125TH ST
NEW YORK NY
10027-4567
US

IV. Provider business mailing address

10 W 135TH ST APT 6H
NEW YORK NY
10037-2612
US

V. Phone/Fax

Practice location:
  • Phone: 212-553-6632
  • Fax:
Mailing address:
  • Phone: 347-203-9917
  • Fax: 347-203-9917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberP138948
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: