Provider Demographics
NPI:1427112879
Name:WATNER, DRYDEN BARCLAY (PHD)
Entity type:Individual
Prefix:
First Name:DRYDEN
Middle Name:BARCLAY
Last Name:WATNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1731
Mailing Address - Country:US
Mailing Address - Phone:929-352-5037
Mailing Address - Fax:
Practice Address - Street 1:216 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1731
Practice Address - Country:US
Practice Address - Phone:929-352-5037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ5150103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00355940OtherAGENCY MEDICAID #
NY1285628552OtherAGENCY NPI
NY00355940OtherAGENCY MEDICAID #