MEDICARE: MISS LARONNA EBONY WATSON MSW

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

General Provider Information

NPI Number	:	1972980340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LARONNA EBONY WATSON MSW

Provider Business Mailing Address
First Line	:	3220 SACRAMENTO ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94702-2726
Country	:	US
Telephone Number	:	510-719-1336
Fax Number	:	209-566-0821

Provider Business Practice Location Address
First Line	:	3220 SACRAMENTO ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94702-2726
Country	:	US
Telephone Number	:	510-719-1336
Fax Number	:	209-566-0821

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

Provider Enumeration Date	:	05/05/2015
Last Update Date	:	01/14/2025

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