Active NPI
Roger John K Watson
- Clinical Social Worker
- Ewa Beach, HI
National Provider Identifier
1245920495
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 4979
- Practice address
- 91-1692 Orrick St
Ewa Beach, HI 96706-2096 - Phone
- (808) 216-9740
- NPI assigned
- May 10, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 4979 | HI | Primary |
Addresses
Primary practice location
91-1692 Orrick St
Ewa Beach, HI 96706-2096
Mailing address
91-1692 Orrick St
Ewa Beach, HI 96706-2096
Phone (808) 216-9740
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4979 | HI | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1683676800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683676800000",
"number": "1245920495",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "91-1692 ORRICK ST",
"city": "EWA BEACH",
"state": "HI",
"postal_code": "967062096",
"telephone_number": "808-216-9740"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "91-1692 ORRICK ST",
"city": "EWA BEACH",
"state": "HI",
"postal_code": "967062096",
"telephone_number": "808-216-9740"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATSON",
"first_name": "ROGER JOHN",
"middle_name": "K",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-05-10",
"last_updated": "2023-05-10",
"certification_date": "2023-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "HI",
"license": "4979",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ewa Beach, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.