Provider Demographics
NPI:1114289493
Name:WINN, MARY ELIZABETH (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:WINN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2395 SAPPHIRE CIR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-5199
Mailing Address - Country:US
Mailing Address - Phone:561-714-5889
Mailing Address - Fax:
Practice Address - Street 1:12161 KEN ADAMS WAY
Practice Address - Street 2:STE 179
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-3191
Practice Address - Country:US
Practice Address - Phone:561-598-8585
Practice Address - Fax:561-227-1510
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW105831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical