Provider Demographics
NPI:1902969892
Name:WATSON, KATHERINE RENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:RENE
Last Name:WATSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 BROADWAY
Mailing Address - Street 2:4TH FL
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5714
Mailing Address - Country:US
Mailing Address - Phone:510-752-1075
Mailing Address - Fax:510-752-1404
Practice Address - Street 1:3505 BROADWAY
Practice Address - Street 2:4TH FL
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5714
Practice Address - Country:US
Practice Address - Phone:510-752-1075
Practice Address - Fax:510-752-1404
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21109103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent