MEDICARE: ANTOINETTE HOWARD

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	175T00000X	Peer Specialist
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDCA.178216	OH

General Provider Information

NPI Number	:	1447915889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTOINETTE HOWARD

Provider Business Mailing Address
First Line	:	4520 PEARSE AVE # UP
Second Line	:
City	:	NEWBURGH HEIGHTS
State	:	OH
Zip	:	44105-3242
Country	:	US
Telephone Number	:	216-468-2627
Fax Number	:

Provider Business Practice Location Address
First Line	:	4520 PEARSE AVE # UP
Second Line	:
City	:	NEWBURGH HEIGHTS
State	:	OH
Zip	:	44105-3242
Country	:	US
Telephone Number	:	216-468-2627
Fax Number	:

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

Provider Enumeration Date	:	11/01/2021
Last Update Date	:	02/10/2022

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Directions to “ ANTOINETTE HOWARD ” Practice Location

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