Healthcare Provider Details

I. General information

NPI: 1760731442
Provider Name (Legal Business Name): STEPHANIE JEAN WATSON-DRAYTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2012
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 E DORSET ST
PHILADELPHIA PA
19150-3117
US

IV. Provider business mailing address

1180 E DORSET ST
PHILADELPHIA PA
19150-3117
US

V. Phone/Fax

Practice location:
  • Phone: 215-868-4321
  • Fax:
Mailing address:
  • Phone: 215-868-4321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCW026841
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: