Provider Demographics
NPI:1144391301
Name:WINTER, KARA LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KARA
Middle Name:LEE
Last Name:WINTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KARA
Other - Middle Name:LEE
Other - Last Name:WINTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:11500 W OLYMPIC BLVD STE 580
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1537
Mailing Address - Country:US
Mailing Address - Phone:510-552-4241
Mailing Address - Fax:
Practice Address - Street 1:11500 W OLYMPIC BLVD STE 580
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1537
Practice Address - Country:US
Practice Address - Phone:510-552-4241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17116103T00000X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5446294Medicare ID - Type Unspecified