MEDICARE: ALISA MARIA WINCHESTER DE

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	104100000X	Social Worker	Q3-0011593	DE
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1669187647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISA MARIA WINCHESTER DE

Provider Business Mailing Address
First Line	:	6850 RICHMOND HWY APT 636
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-1775
Country	:	US
Telephone Number	:	302-507-2388
Fax Number	:

Provider Business Practice Location Address
First Line	:	17320 W 12 MILE RD
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076-2100
Country	:	US
Telephone Number	:	248-727-3456
Fax Number	:	248-557-4697

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

Provider Enumeration Date	:	01/13/2023
Last Update Date	:	12/17/2025

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