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General NPI Number Information
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NPI Number | 1114615424
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Entity Type | Individual
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Provider Name | CHRISTOPHER LEON LOUIS WATKINS PSYD
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Gender | Male
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Dates
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Enumeration Date | 04/25/2023
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 921 CHESTER PIKE
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City | SHARON HILL
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State | PA
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Zip | 19079-1411
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Country | US
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Telephone | 610-583-1177
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Fax |
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Provider Business Mailing Address
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Address Line | 45 E CITY AVE # 1712
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City | BALA CYNWYD
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State | PA
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Zip | 19004-2421
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS019967
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License Number State | PA
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