=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477672434
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JUDITH A WINTERS LCSW INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 175 S LAKE AVE UNIT 201
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91101-2629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-590-7912
-----------------------------------------------------
Fax | 818-249-5036
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 12271
-----------------------------------------------------
City | LA CRESCENTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91224-0971
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-590-7912
-----------------------------------------------------
Fax | 818-249-5036
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | JUDITH A WINTERS
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 626-590-7912
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LCS 20588
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------