Provider Demographics
NPI:1902904543
Name:WATSON, ANDRE STEVEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:STEVEN
Last Name:WATSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 S 16TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-4908
Mailing Address - Country:US
Mailing Address - Phone:215-732-8244
Mailing Address - Fax:215-732-8454
Practice Address - Street 1:313 S 16TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-4908
Practice Address - Country:US
Practice Address - Phone:215-732-8244
Practice Address - Fax:215-732-8454
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016210103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical