Provider Demographics
NPI:1194615278
Name:WATSON, BRENNA ELLEN
Entity type:Individual
Prefix:
First Name:BRENNA
Middle Name:ELLEN
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:679 OWL DR
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-7242
Mailing Address - Country:US
Mailing Address - Phone:707-628-7015
Mailing Address - Fax:
Practice Address - Street 1:3333 VACA VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-9421
Practice Address - Country:US
Practice Address - Phone:707-474-9949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent