Healthcare Provider Details

I. General information

NPI: 1619945565
Provider Name (Legal Business Name): ELIZABETH H WINSLOW LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 WHITE AVE BLDG 114
BROOKLYN NY
11252
US

IV. Provider business mailing address

PAHC 1075 STEPHENSON AVE ATTN CREDENTIALS OFFICE
FORT MONMOUTH NJ
07703-5000
US

V. Phone/Fax

Practice location:
  • Phone: 718-630-4242
  • Fax: 718-630-4337
Mailing address:
  • Phone: 732-532-0182
  • Fax: 732-532-0194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR0581801
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: