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General NPI Number Information
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NPI Number | 1568451805
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Entity Type | Individual
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Provider Name | BRUCE ROBERT WATSON MSW
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Gender | Male
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Dates
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Enumeration Date | 10/19/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1687 ERRINGER RD STE. 202B
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City | SIMI VALLEY
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State | CA
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Zip | 93065-6508
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Country | US
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Telephone | 805-526-8534
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Fax |
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Provider Business Mailing Address
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Address Line | 6144 FREMONT CIRCLE
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City | CAMARILLO
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State | CA
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Zip | 93012
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Country | US
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Telephone | 805-373-0233
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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 | LCS 5676
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License Number State | CA
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