Provider Demographics
NPI:1275391062
Name:JACOB MAX WINKLER LLC
Entity Type:Organization
Organization Name:JACOB MAX WINKLER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:MAX
Authorized Official - Last Name:WINKLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:804-404-5679
Mailing Address - Street 1:320 RARITAN AVE STE 304A
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2752
Mailing Address - Country:US
Mailing Address - Phone:804-404-5679
Mailing Address - Fax:
Practice Address - Street 1:320 RARITAN AVE STE 304A
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2752
Practice Address - Country:US
Practice Address - Phone:804-404-5679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty