MEDICARE: MS. DONNA LEAH WATSON LCSW

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	1041C0700X	Clinical Social Worker	SW 12210	FL

General Provider Information

NPI Number	:	1780071803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DONNA LEAH WATSON LCSW

Provider Business Mailing Address
First Line	:	3620 GOYA CT
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32504-4522
Country	:	US
Telephone Number	:	850-206-4845
Fax Number	:	850-438-4649

Provider Business Practice Location Address
First Line	:	7100 PLANTATION RD STE 11
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32504-6234
Country	:	US
Telephone Number	:	850-206-4845
Fax Number	:	850-438-4649

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

Provider Enumeration Date	:	04/16/2015
Last Update Date	:	02/26/2019

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