Healthcare Provider Details

I. General information

NPI: 1356445076
Provider Name (Legal Business Name): JEAN A WINSLOW LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CHELMSFORD STREET 2ND FLOOR
CHELMSFORD MA
01824
US

IV. Provider business mailing address

128 WARREN ST #17
LOWELL MA
01852-2284
US

V. Phone/Fax

Practice location:
  • Phone: 978-256-1467
  • Fax: 978-256-7465
Mailing address:
  • Phone: 978-455-2366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number333
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: