Provider Demographics
NPI:1639920309
Name:WINIARZ, KRISTIAN (PSYD, MA)
Entity Type:Individual
Prefix:DR
First Name:KRISTIAN
Middle Name:
Last Name:WINIARZ
Suffix:
Gender:M
Credentials:PSYD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 W BERKS ST APT 305
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19122-2463
Mailing Address - Country:US
Mailing Address - Phone:302-438-6249
Mailing Address - Fax:
Practice Address - Street 1:173 W BERKS ST APT 305
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19122-2463
Practice Address - Country:US
Practice Address - Phone:302-635-0560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS019951103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical