Provider Demographics
NPI:1194039131
Name:FANT, WINNIE W (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:WINNIE
Middle Name:W
Last Name:FANT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 NORTH STATION PLAZA
Mailing Address - Street 2:COPAY INC.
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021
Mailing Address - Country:US
Mailing Address - Phone:516-466-2509
Mailing Address - Fax:516-482-3146
Practice Address - Street 1:21 NORTH STATION PLAZA
Practice Address - Street 2:COPAY INC.
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021
Practice Address - Country:US
Practice Address - Phone:516-466-2509
Practice Address - Fax:516-482-3146
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043255106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist