Provider Demographics
NPI:1801342472
Name:WATSON, CYNTHIA (MSW)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 LATIGO LN STE G
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-8113
Mailing Address - Country:US
Mailing Address - Phone:719-275-9799
Mailing Address - Fax:719-896-2874
Practice Address - Street 1:2429 S. PRAIRIE AVENUE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005
Practice Address - Country:US
Practice Address - Phone:719-564-5070
Practice Address - Fax:719-896-2874
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0106660101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor