Provider Demographics
NPI:1346221934
Name:WINN, RICHARD E JR (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:WINN
Suffix:JR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:BRAZIL
Mailing Address - State:IN
Mailing Address - Zip Code:47834-2244
Mailing Address - Country:US
Mailing Address - Phone:812-448-9440
Mailing Address - Fax:
Practice Address - Street 1:527 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:BRAZIL
Practice Address - State:IN
Practice Address - Zip Code:47834-2244
Practice Address - Country:US
Practice Address - Phone:812-448-9440
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041472A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical