Provider Demographics
NPI:1093830192
Name:WATSON, MATTHEW (LCSW)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:WATSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 S EL DORADO CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-1044
Mailing Address - Country:US
Mailing Address - Phone:480-968-2995
Mailing Address - Fax:480-967-4103
Practice Address - Street 1:235 S EL DORADO CIR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-1044
Practice Address - Country:US
Practice Address - Phone:480-968-2995
Practice Address - Fax:480-967-4103
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0034721041C0700X
TNLSW00000047031041C0700X
AL1959C1041C0700X
AZ124351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical