Provider Demographics
NPI:1710248661
Name:WATTS, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:WATTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 N COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10553-1038
Mailing Address - Country:US
Mailing Address - Phone:914-424-4474
Mailing Address - Fax:914-663-7075
Practice Address - Street 1:51 N COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10553-1038
Practice Address - Country:US
Practice Address - Phone:914-424-4474
Practice Address - Fax:914-663-7075
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator