Provider Demographics
NPI:1558571430
Name:TERRY, KATE VAN WINKLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KATE
Middle Name:VAN WINKLE
Last Name:TERRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:KATE
Other - Middle Name:VAN WINKLE
Other - Last Name:TERRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1896 TIGERTAIL AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-3350
Mailing Address - Country:US
Mailing Address - Phone:305-860-0647
Mailing Address - Fax:305-854-5495
Practice Address - Street 1:3400 DEVON RD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-6202
Practice Address - Country:US
Practice Address - Phone:305-860-0647
Practice Address - Fax:305-854-5495
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW54281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ117BOtherBLUE CROSS BLUE SHIELD