Provider Demographics
NPI:1386184299
Name:DR. SAMANTHA WINTON, LLC
Entity Type:Organization
Organization Name:DR. SAMANTHA WINTON, LLC
Other - Org Name:INTEGRATED CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOLOGIST / CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:727-490-8811
Mailing Address - Street 1:33 6TH ST S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4153
Mailing Address - Country:US
Mailing Address - Phone:727-490-8811
Mailing Address - Fax:
Practice Address - Street 1:33 6TH ST S
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4153
Practice Address - Country:US
Practice Address - Phone:727-490-8811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9464103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty