Healthcare Provider Details

I. General information

NPI: 1083161368
Provider Name (Legal Business Name): NANCY WATT MARIN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2016
Last Update Date: 09/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5060 37TH ST N
ARLINGTON VA
22207-1823
US

IV. Provider business mailing address

5060 37TH ST N
ARLINGTON VA
22207-1823
US

V. Phone/Fax

Practice location:
  • Phone: 202-427-9015
  • Fax:
Mailing address:
  • Phone: 202-427-9015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number0810005342
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: