MEDICARE: LORRAINE WINCOR P.A.

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	103T00000X	Psychologist	0003464	FL

General Provider Information

NPI Number	:	1700191863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LORRAINE WINCOR P.A.

Provider Business Mailing Address
First Line	:	3200 PORT ROYALE DR.
Second Line	:	# 1203
City	:	FT. LAUDERDALE
State	:	FL
Zip	:	33308-7805
Country	:	US
Telephone Number	:	954-772-6015
Fax Number	:	954-772-6099

Provider Business Practice Location Address
First Line	:	3200 PORT ROYALE DR
Second Line	:	# 1203
City	:	FT. LAUDERDALE
State	:	FL
Zip	:	33308-7805
Country	:	US
Telephone Number	:	954-772-6015
Fax Number	:	954-772-6099

Authorized Official
Title or Position	:	DR.
Name	:	DR. LORRAINE WINCOR
Credential	:	PSYD.
Telephone Number	:	954-772-6015

Provider Enumeration Date	:	08/13/2010
Last Update Date	:	08/13/2010

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