MEDICARE: TENISHA 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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1518743962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TENISHA WATT

Provider Business Mailing Address
First Line	:	894 FOUNTAIN AVE APT 229
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11239-2639
Country	:	US
Telephone Number	:	917-403-2557
Fax Number	:

Provider Business Practice Location Address
First Line	:	894 FOUNTAIN AVE APT 229
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11239-2639
Country	:	US
Telephone Number	:	917-403-2557
Fax Number	:

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

Provider Enumeration Date	:	09/01/2023
Last Update Date	:	09/01/2023

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Directions to “ TENISHA WATT ” Practice Location

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