Provider Demographics
NPI:1962602243
Name:WATSON, ROY GLENN (LCSW)
Entity type:Individual
Prefix:MR
First Name:ROY
Middle Name:GLENN
Last Name:WATSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 85129
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99708-5129
Mailing Address - Country:US
Mailing Address - Phone:907-479-9459
Mailing Address - Fax:907-479-4311
Practice Address - Street 1:600 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-3643
Practice Address - Country:US
Practice Address - Phone:907-479-9459
Practice Address - Fax:907-479-4311
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical