Provider Demographics
NPI:1942893698
Name:WATT, CAROLINE H (LCAT, RDT)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:H
Last Name:WATT
Suffix:
Gender:F
Credentials:LCAT, RDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 SAINT JOHNS PL APT 4A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-3418
Mailing Address - Country:US
Mailing Address - Phone:216-469-1690
Mailing Address - Fax:
Practice Address - Street 1:229 SAINT JOHNS PL APT 4A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-3418
Practice Address - Country:US
Practice Address - Phone:847-814-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-13
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002144101Y00000X, 221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor