Healthcare Provider Details

I. General information

NPI: 1689053167
Provider Name (Legal Business Name): BETTY WINKLER LCAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2015
Last Update Date: 06/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1276 FULTON AVE
BRONX NY
10456-3402
US

IV. Provider business mailing address

1276 FULTON AVE
BRONX NY
10456
US

V. Phone/Fax

Practice location:
  • Phone: 718-992-7669
  • Fax:
Mailing address:
  • Phone: 718-901-8918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number001328-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: