=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346126141
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SEDRICK B WATKINS JR.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2025
-----------------------------------------------------
Last Update Date | 08/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7500 GREENWAY CENTER DR
-----------------------------------------------------
City | GREENBELT
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20770-3502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-585-9595
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10714 DRAGOO PL
-----------------------------------------------------
City | CLINTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20735-3902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-910-8464
-----------------------------------------------------
Fax | 301-910-8464
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------