Provider Demographics
NPI:1346306933
Name:WINNUBST, CAECILIA M
Entity Type:Individual
Prefix:DR
First Name:CAECILIA
Middle Name:M
Last Name:WINNUBST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:652 N AMBERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-5805
Mailing Address - Country:US
Mailing Address - Phone:928-526-4433
Mailing Address - Fax:928-526-7477
Practice Address - Street 1:652 N AMBERWOOD ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-5805
Practice Address - Country:US
Practice Address - Phone:928-526-4433
Practice Address - Fax:928-526-7477
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW 24661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical