Watanabe Psychological Services, LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

WATANABE PSYCHOLOGICAL SERVICES, LLC

Practice address

429 Littlecroft Rd
Upper Darby, PA 19082-4909

Phone

(215) 550-1722

NPI assigned

Apr 10, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mimiko Watanabe, PSYDNPI 1528437704

Title

Owner

Phone

(215) 550-1722

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mimiko Watanabe

  • Clinical Psychologist
  • Philadelphia, PA
  • NPI 1528437704
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1712707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712707200000",
    "number": "1942053749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "429 LITTLECROFT RD",
            "city": "UPPER DARBY",
            "state": "PA",
            "postal_code": "190824909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "429 LITTLECROFT RD",
            "city": "UPPER DARBY",
            "state": "PA",
            "postal_code": "190824909",
            "telephone_number": "215-550-1722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATANABE PSYCHOLOGICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-10",
        "last_updated": "2024-04-10",
        "certification_date": "2024-03-28",
        "status": "A",
        "authorized_official_last_name": "WATANABE",
        "authorized_official_first_name": "MIMIKO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "215-550-1722",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Virtual Preventive Care Services
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• Augie Wallace
• Maureen C. Walsh, MPT
• Eileen Wang
• Jerry Jermaine Watlington
• Samantha Weaver
• Lee Gregory Weinstein, D.C.
• Lashay Nadjah Wiley
• Linsey A Will, CRNP

• Clinical Psychologist in Upper Darby, PA
• Providers in Upper Darby, PA by specialty
• Clinical Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.