Provider Demographics
NPI:1134330855
Name:WINETZKY, RICHARD MARK (LMFT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:MARK
Last Name:WINETZKY
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:969G EDGEWATER BLVD # 846
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-3760
Mailing Address - Country:US
Mailing Address - Phone:415-609-2530
Mailing Address - Fax:650-312-1144
Practice Address - Street 1:1700 S AMPHLETT BLVD
Practice Address - Street 2:SUITE 250D
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2701
Practice Address - Country:US
Practice Address - Phone:650-863-7753
Practice Address - Fax:650-312-1144
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 50274106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist