Active NPI
Seren Watters
- Behavior Technician
- Walnut Creek, CA
National Provider Identifier
1740942689
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 710 S Broadway
Walnut Creek, CA 94596-5294 - Phone
- (925) 968-8648
- NPI assigned
- Oct 7, 2021
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1104368844 | CA | |
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
710 S Broadway
Walnut Creek, CA 94596-5294
Mailing address
710 S Broadway
Walnut Creek, CA 94596-5294
Phone (925) 968-8648
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| F7660589 | Other | CA | DRIVER LICENSE |
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 |
|---|---|---|---|
| 1104368844 | CA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1633564800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636329600000",
"number": "1740942689",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "710 S BROADWAY",
"city": "WALNUT CREEK",
"state": "CA",
"postal_code": "945965294",
"telephone_number": "925-968-8648"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "710 S BROADWAY",
"city": "WALNUT CREEK",
"state": "CA",
"postal_code": "945965294",
"telephone_number": "925-968-8648"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATTERS",
"first_name": "SEREN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-10-07",
"last_updated": "2021-11-08",
"certification_date": "2021-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "CA",
"license": "1104368844",
"primary": false
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DRIVER LICENSE",
"identifier": "F7660589",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Walnut Creek, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.