Provider Demographics
NPI:1114025434
Name:WINNEGA, MARREA A (PHD)
Entity Type:Individual
Prefix:
First Name:MARREA
Middle Name:A
Last Name:WINNEGA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1747 W ROOSEVELT RD
Mailing Address - Street 2:ROOM 155, M/C 747
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-1264
Mailing Address - Country:US
Mailing Address - Phone:312-996-0357
Mailing Address - Fax:312-355-3634
Practice Address - Street 1:1747 W ROOSEVELT RD
Practice Address - Street 2:ROOM 155, M/C 747
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1264
Practice Address - Country:US
Practice Address - Phone:312-996-0357
Practice Address - Fax:312-355-3634
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0710046632084P0804X, 103TC0700X, 103TM1800X
IL1118506103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities