Healthcare Provider Details

I. General information

NPI: 1902904543
Provider Name (Legal Business Name): ANDRE STEVEN WATSON PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 S 16TH ST
PHILADELPHIA PA
19102-4908
US

IV. Provider business mailing address

313 S 16TH ST
PHILADELPHIA PA
19102-4908
US

V. Phone/Fax

Practice location:
  • Phone: 215-732-8244
  • Fax: 215-732-8454
Mailing address:
  • Phone: 215-732-8244
  • Fax: 215-732-8454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS016210
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: