Provider Demographics
NPI:1245858802
Name:WATTS, AEVON JENENE
Entity type:Individual
Prefix:
First Name:AEVON
Middle Name:JENENE
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 1:9713 N NEW RIVER CANAL RD
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3423
Mailing Address - Country:US
Mailing Address - Phone:516-376-7550
Mailing Address - Fax:
Practice Address - Street 1:10311 NW 58TH ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2819
Practice Address - Country:US
Practice Address - Phone:305-597-4545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician