Individual
GLEN WATSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CASAC-T
Contact information
Practice address
764 E 176TH ST, BRONX, NY 10460-4606
(718) 542-8770
Mailing address
1332 HERKIMER ST, BROOKLYN, NY 11233-6129
(347) 358-2723
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
07/08/2022
Last updated
07/08/2022
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