Provider Demographics
NPI:1487788410
Name:WATT, VANESSA SUE (MFT)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:SUE
Last Name:WATT
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3821 23RD ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-3320
Mailing Address - Country:US
Mailing Address - Phone:415-821-7517
Mailing Address - Fax:415-821-2230
Practice Address - Street 1:3821 23RD ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-3320
Practice Address - Country:US
Practice Address - Phone:415-821-7517
Practice Address - Fax:415-821-2230
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT30986101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health