Healthcare Provider Details

I. General information

NPI: 1043120157
Provider Name (Legal Business Name): PRACTICE OF WINELL SOURES LCSW, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 NEW KARNER RD
ALBANY NY
12205-4627
US

IV. Provider business mailing address

20 BELDALE RD
SLINGERLANDS NY
12159-9656
US

V. Phone/Fax

Practice location:
  • Phone: 518-417-1597
  • Fax: 518-718-4367
Mailing address:
  • Phone: 518-331-8397
  • Fax: 518-718-4367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. WINELL SOURES, SOURES
Title or Position: OWNER, PSYCHOTHERAPIST
Credential: LCSW
Phone: 518-331-8397