Healthcare Provider Details

I. General information

NPI: 1013446830
Provider Name (Legal Business Name): LENA ROSE WINTERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2488 N BEACHWOOD DR APT 3
LOS ANGELES CA
90068-3396
US

IV. Provider business mailing address

2488 N BEACHWOOD DR APT 3
LOS ANGELES CA
90068-3396
US

V. Phone/Fax

Practice location:
  • Phone: 323-630-5957
  • Fax:
Mailing address:
  • Phone: 323-630-5957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089502
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number107965
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: