Provider Demographics
NPI:1780872911
Name:WATSON-LASTER, DEBORAH ALICE (PHD, MA)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:ALICE
Last Name:WATSON-LASTER
Suffix:
Gender:F
Credentials:PHD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3170 ASHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-2850
Mailing Address - Country:US
Mailing Address - Phone:216-561-2545
Mailing Address - Fax:216-431-2190
Practice Address - Street 1:3170 ASHWOOD RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-2850
Practice Address - Country:US
Practice Address - Phone:216-561-2545
Practice Address - Fax:216-431-2190
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE1407101YP2500X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral