Provider Demographics
NPI:1639570690
Name:CAROL MADDEN WINSLOW
Entity Type:Organization
Organization Name:CAROL MADDEN WINSLOW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:MADDEN
Authorized Official - Last Name:WINSLOW
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, LADC
Authorized Official - Phone:860-287-7203
Mailing Address - Street 1:83 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-2423
Mailing Address - Country:US
Mailing Address - Phone:860-287-7203
Mailing Address - Fax:
Practice Address - Street 1:18 MYROCK AVE
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-3008
Practice Address - Country:US
Practice Address - Phone:860-287-7203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000676261QM0850X
CT000838261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health