Healthcare Provider Details

I. General information

NPI: 1770024960
Provider Name (Legal Business Name): CHARLES WINICK PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2017
Last Update Date: 03/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 GRIFFIN RD STE 101
DAVIE FL
33328-3320
US

IV. Provider business mailing address

10400 GRIFFIN RD STE 101
DAVIE FL
33328-3320
US

V. Phone/Fax

Practice location:
  • Phone: 954-436-8326
  • Fax: 954-434-8572
Mailing address:
  • Phone: 954-436-8326
  • Fax: 954-434-8572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY0004966
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPY0004966
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: