MEDICARE: SHAUN BERRY WINTERS LCSW

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	1041C0700X	Clinical Social Worker	34009756A	IN

General Provider Information

NPI Number	:	1790326312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAUN BERRY WINTERS LCSW

Provider Business Mailing Address
First Line	:	1707 HIGH ST
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46808-2583
Country	:	US
Telephone Number	:	765-372-1451
Fax Number	:

Provider Business Practice Location Address
First Line	:	1707 HIGH ST
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46808-2583
Country	:	US
Telephone Number	:	765-372-1451
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2019
Last Update Date	:	03/25/2026

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