Provider Demographics
NPI:1427397470
Name:WINSTON, LARAINE (LMHC, BCBA)
Entity Type:Individual
Prefix:
First Name:LARAINE
Middle Name:
Last Name:WINSTON
Suffix:
Gender:F
Credentials:LMHC, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 SW 36TH ST
Mailing Address - Street 2:# 9
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-1915
Mailing Address - Country:US
Mailing Address - Phone:954-483-6251
Mailing Address - Fax:954-577-7780
Practice Address - Street 1:8001 SW 36TH ST
Practice Address - Street 2:# 9
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-1915
Practice Address - Country:US
Practice Address - Phone:954-483-6251
Practice Address - Fax:954-577-7780
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6683101YM0800X
FL1-00-0214103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst