Healthcare Provider Details

I. General information

NPI: 1720302573
Provider Name (Legal Business Name): ELLEN MARIE WINKLER LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2010
Last Update Date: 03/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

584 ALBANY TPKE #2
OLD CHATHAM NY
12136-2304
US

IV. Provider business mailing address

PO BOX 195
GHENT NY
12075-0195
US

V. Phone/Fax

Practice location:
  • Phone: 310-430-6902
  • Fax:
Mailing address:
  • Phone: 310-430-6902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number000730
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: