Provider Demographics
NPI:1669656674
Name:WINIG, JAY HOWARD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:HOWARD
Last Name:WINIG
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3518 LACLEDE AVE
Mailing Address - Street 2:MARCHETTI TOWERS EAST
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-2011
Mailing Address - Country:US
Mailing Address - Phone:314-977-2833
Mailing Address - Fax:
Practice Address - Street 1:3518 LACLEDE AVE
Practice Address - Street 2:MARCHETTI TOWERS EAST
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103-2011
Practice Address - Country:US
Practice Address - Phone:314-977-2833
Practice Address - Fax:314-977-7165
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20080324361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical