Provider Demographics
NPI:1538747118
Name:WATTS, ANTOINETTE ANGELIQUE (CSW)
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:ANGELIQUE
Last Name:WATTS
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 HIGHLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-1392
Mailing Address - Country:US
Mailing Address - Phone:513-655-7154
Mailing Address - Fax:
Practice Address - Street 1:1810 HIGHLAND AVENUE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-1392
Practice Address - Country:US
Practice Address - Phone:513-655-7154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6832171M00000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY86-2772824Medicaid
KY862772824OtherSUD