MEDICARE: ANTOINETTE ANGELIQUE WATTS CSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator	6832	KY
2	104100000X	Social Worker	6832	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	862772824	OTHER	KY	SUD

General Provider Information

NPI Number	:	1538747118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTOINETTE ANGELIQUE WATTS CSW

Provider Business Mailing Address
First Line	:	1810 HIGHLAND AVENUE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45202-1392
Country	:	US
Telephone Number	:	513-655-7154
Fax Number	:

Provider Business Practice Location Address
First Line	:	1810 HIGHLAND AVENUE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45202-1392
Country	:	US
Telephone Number	:	513-655-7154
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2021
Last Update Date	:	03/01/2024

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