Individual
CLINAE WATSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4401 CRENSHAW BLVD, LOS ANGELES, CA 90043-1227
(323) 290-8360
Mailing address
3031 S VERMONT AVE, LOS ANGELES, CA 90007-3033
(323) 373-2400
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
94026403
CA
106S00000X
Behavior Technician
—
—
225400000X
Rehabilitation Practitioner
—
—
Other
Enumeration date
01/12/2018
Last updated
02/07/2022
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