Provider Demographics
NPI:1285605899
Name:WATSON, ROBERT S (PSYD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:WATSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 NEW LAGRANGE RD
Mailing Address - Street 2:STE 312
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4870
Mailing Address - Country:US
Mailing Address - Phone:502-394-9990
Mailing Address - Fax:502-394-9992
Practice Address - Street 1:7400 NEW LAGRANGE RD
Practice Address - Street 2:STE 312
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4870
Practice Address - Country:US
Practice Address - Phone:502-394-9990
Practice Address - Fax:502-394-9992
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1149103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7744156OtherAETNA
KY000000175842OtherANTHEM BCBS
KY114601OtherUNITED BEHAVIORAL HEALTH
KY239617OtherMHN
KY8900010300Medicaid
KY089772000OtherMAGELLAN
KY181677OtherCOMPSYCH
KY476948OtherVALUE OPTIONS
KY680005474Medicare PIN
KY8900010300Medicaid
KY476948OtherVALUE OPTIONS