MEDICARE: DR. LISA MARIA WININGS PSY.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
1	103TC0700X	Clinical Psychologist	PY6851	FL

General Provider Information

NPI Number	:	1497801021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA MARIA WININGS PSY.D.

Provider Business Mailing Address
First Line	:	1725 N UNIVERSITY DR
Second Line	:	SUITE 350
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-6089
Country	:	US
Telephone Number	:	954-755-0909
Fax Number	:	954-755-5692

Provider Business Practice Location Address
First Line	:	1725 N UNIVERSITY DR
Second Line	:	SUITE 350
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-6089
Country	:	US
Telephone Number	:	954-755-0909
Fax Number	:	954-755-5692

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

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	09/21/2007

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