Provider Demographics
NPI:1407523020
Name:WINSEMAN, MANDA MICHELLE
Entity Type:Individual
Prefix:
First Name:MANDA
Middle Name:MICHELLE
Last Name:WINSEMAN
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 1:7803 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:NY
Mailing Address - Zip Code:14485-9774
Mailing Address - Country:US
Mailing Address - Phone:585-415-1280
Mailing Address - Fax:
Practice Address - Street 1:7803 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:NY
Practice Address - Zip Code:14485-9774
Practice Address - Country:US
Practice Address - Phone:585-415-1280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064212104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker