Provider Demographics
NPI:1982431748
Name:WATSON, TIMOTHY (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:WATSON
Suffix:
Gender:M
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 LASHER AVE
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12526-5816
Mailing Address - Country:US
Mailing Address - Phone:518-763-8906
Mailing Address - Fax:
Practice Address - Street 1:95 LASHER AVE
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:NY
Practice Address - Zip Code:12526-5816
Practice Address - Country:US
Practice Address - Phone:518-763-8906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003325-01103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst