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General NPI Number Information
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NPI Number | 1386926020
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Entity Type | Individual
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Provider Name | MS. CALYSTA R WATSON
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Gender | Female
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Dates
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Enumeration Date | 09/19/2011
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3600 BROADWAY
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City | OAKLAND
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State | CA
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Zip | 94611-5730
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Country | US
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Telephone | 510-915-8200
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Fax |
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Provider Business Mailing Address
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Address Line | 340 S. LEMON AVE. #2572
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City | WALNUT
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State | CA
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Zip | 91789
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Country | US
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Telephone | 323-735-3822
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW78826
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License Number State | CA
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