Basic Information
| Provider Information | |||||||||
| NPI: | 1407382724 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WATSON | ||||||||
| FirstName: | STACEY-ANN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LMSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FRANCIS | ||||||||
| OtherFirstName: | STACEY-ANN | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 135 LOCUST HILL AVE | ||||||||
| Address2: | C/O MARTIN LUTHER KING JR ELEMENTARY SCHOOL WJCS PG | ||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107012917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9143768174 | ||||||||
| FaxNumber: | 9143763715 | ||||||||
| Practice Location | |||||||||
| Address1: | 135 LOCUST HILL AVE | ||||||||
| Address2: | C/O MARTIN LUTHER KING JR ELEMENTARY SCHOOL WJCS PG | ||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107012917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9143768174 | ||||||||
| FaxNumber: | 9143763715 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2017 | ||||||||
| LastUpdateDate: | 05/05/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 093644 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.