Healthcare Provider Details

I. General information

NPI: 1356533004
Provider Name (Legal Business Name): BERNARD MARTIN WINKEL ED.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 VERMONT AVE NW
WASHINGTON DC
20420-0001
US

IV. Provider business mailing address

810 VERMONT AVE NW
WASHINGTON DC
20420-0001
US

V. Phone/Fax

Practice location:
  • Phone: 202-461-4101
  • Fax: 202-501-2196
Mailing address:
  • Phone: 202-461-4101
  • Fax: 202-501-2196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number888
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number212
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: