Healthcare Provider Details

I. General information

NPI: 1699663344
Provider Name (Legal Business Name): JESSE WARREN WINNICKI LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 11TH ST
NIAGARA FALLS NY
14301-1201
US

IV. Provider business mailing address

3473 S PARK AVE LOT A16
BLASDELL NY
14219-1000
US

V. Phone/Fax

Practice location:
  • Phone: 716-278-8110
  • Fax:
Mailing address:
  • Phone: 585-643-9331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: