MEDICARE: ELLEN E WIJNBERG LCSW

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
1	1041C0700X	Clinical Social Worker	005629	CT
2	1041C0700X	Clinical Social Worker	SW4967	FL

General Provider Information

NPI Number	:	1255405932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN E WIJNBERG LCSW

Provider Business Mailing Address
First Line	:	6600 UNIVERSITY PKWY STE 304
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34240-9048
Country	:	US
Telephone Number	:	833-769-3524
Fax Number	:

Provider Business Practice Location Address
First Line	:	6600 UNIVERSITY PKWY STE 304
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34240-9048
Country	:	US
Telephone Number	:	833-769-3524
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	09/22/2023

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Directions to “ ELLEN E WIJNBERG LCSW” Practice Location

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