MEDICARE: 479 WATT

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1508701616
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	479 WATT

Provider Business Mailing Address
First Line	:	3970 CARRIE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-3412
Country	:	US
Telephone Number	:	513-549-3095
Fax Number	:

Provider Business Practice Location Address
First Line	:	3970 CARRIE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-3412
Country	:	US
Telephone Number	:	513-549-3095
Fax Number	:

Authorized Official
Title or Position	:	PEER SUPPORT
Name	:	KENMAR YONDRA WATTERSON
Credential	:	CPRS
Telephone Number	:	513-549-3095

Provider Enumeration Date	:	04/23/2026
Last Update Date	:	04/23/2026

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Directions to “479 WATT ” Practice Location

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