Provider Demographics
NPI:1699293183
Name:WATSON, LISA CAMILLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:CAMILLE
Last Name:WATSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7754 OKEECHOBEE BLVD STE 919
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-2104
Mailing Address - Country:US
Mailing Address - Phone:954-574-2760
Mailing Address - Fax:
Practice Address - Street 1:7754 OKEECHOBEE BLVD STE 919
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-2104
Practice Address - Country:US
Practice Address - Phone:954-574-2760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPSY11497103TC0700X
FLPY9944103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical