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General NPI Number Information
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NPI Number | 1568594042
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Entity Type | Individual
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Provider Name | SAMUEL STEWART WATSON LCSW
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Gender | Male
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Dates
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Enumeration Date | 03/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 160 S RIVER ST
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City | HACKENSACK
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State | NJ
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Zip | 07601-6925
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Country | US
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Telephone | 201-527-3000
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Fax | 201-527-3027
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Provider Business Mailing Address
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Address Line | 333 LIBERTY ST #18
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City | LITTLE FERRY
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State | NJ
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Zip | 07643-1360
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Country | US
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Telephone | 201-641-2261
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Fax | 201-641-2261
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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 | 44SC04819700
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License Number State | NJ
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