MEDICARE: DR. LISA CAMILLE WATSON PSYD

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	PSY11497	MA
2	103TC0700X	Clinical Psychologist	PY9944	FL

General Provider Information

NPI Number	:	1699293183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA CAMILLE WATSON PSYD

Provider Business Mailing Address
First Line	:	7754 OKEECHOBEE BLVD STE 919
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-2104
Country	:	US
Telephone Number	:	954-574-2760
Fax Number	:

Provider Business Practice Location Address
First Line	:	7754 OKEECHOBEE BLVD STE 919
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-2104
Country	:	US
Telephone Number	:	954-574-2760
Fax Number	:

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

Provider Enumeration Date	:	09/05/2017
Last Update Date	:	12/23/2024

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