Provider Demographics
NPI:1427705607
Name:WATSON, LENNIS (MSED)
Entity type:Individual
Prefix:
First Name:LENNIS
Middle Name:
Last Name:WATSON
Suffix:
Gender:M
Credentials:MSED
Other - Prefix:
Other - First Name:LENNIS
Other - Middle Name:
Other - Last Name:TYLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2213 N NINE MILE RD # A
Mailing Address - Street 2:
Mailing Address - City:ALLEGANY
Mailing Address - State:NY
Mailing Address - Zip Code:14706-9704
Mailing Address - Country:US
Mailing Address - Phone:716-307-8245
Mailing Address - Fax:
Practice Address - Street 1:2213 N NINE MILE RD # A
Practice Address - Street 2:
Practice Address - City:ALLEGANY
Practice Address - State:NY
Practice Address - Zip Code:14706-9704
Practice Address - Country:US
Practice Address - Phone:716-307-8245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101Y00000X, 101YA0400X, 101YP2500X, 101YS0200X, 102L00000X, 103K00000X, 106H00000X, 106S00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician