Provider Demographics
NPI:1376652552
Name:HENTSCHEL, WINFRED J (EDD)
Entity Type:Individual
Prefix:DR
First Name:WINFRED
Middle Name:J
Last Name:HENTSCHEL
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:DR
Other - First Name:WINIFRED
Other - Middle Name:H
Other - Last Name:SACHS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDD
Mailing Address - Street 1:22 HILLIARD STREET
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4832
Mailing Address - Country:US
Mailing Address - Phone:617-497-9027
Mailing Address - Fax:617-497-1244
Practice Address - Street 1:12 ASH ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4832
Practice Address - Country:US
Practice Address - Phone:617-497-9027
Practice Address - Fax:617-497-1244
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPSY 7196103G00000X
MA7196103T00000X, 103TA0400X, 103TA0700X, 103TB0200X, 103TC0700X, 103TC1900X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0526398OtherMASS HEALTH
MAW05763OtherBCBS
MAW05763OtherBCBS