MEDICARE: DR. AMY T WATT PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY 15386	CA

General Provider Information

NPI Number	:	1649364068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY T WATT PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 2791
Second Line	:
City	:	SAN RAMON
State	:	CA
Zip	:	94583-7791
Country	:	US
Telephone Number	:	415-498-0753
Fax Number	:	415-963-3398

Provider Business Practice Location Address
First Line	:	3996 MISSION ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94112-1050
Country	:	US
Telephone Number	:	415-498-0753
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	02/15/2018

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