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NPI Code Detail

MEDICARE: MARREA A. WINNEGA PH.D.

MEDICARE: MARREA A. WINNEGA PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0804XChild & Adolescent Psychiatry Physician071004663IL
2103TC0700XClinical Psychologist071004663IL
3103K00000XBehavior Analyst1118506IL
4103TM1800XIntellectual & Developmental Disabilities Psychologist071004663IL

General Provider Information

NPI Number : 1114025434
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARREA A. WINNEGA PH.D.
Provider Business Mailing Address
First Line : 1747 W ROOSEVELT RD
Second Line : ROOM 155, M/C 747
City : CHICAGO
State : IL
Zip : 60608-1264
Country : US
Telephone Number : 312-996-0357
Fax Number : 312-355-3634
Provider Business Practice Location Address
First Line : 1747 W ROOSEVELT RD
Second Line : ROOM 155, M/C 747
City : CHICAGO
State : IL
Zip : 60608-1264
Country : US
Telephone Number : 312-996-0357
Fax Number : 312-355-3634
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 06/24/2011

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