Provider Demographics
NPI:1699815290
Name:WINTER, NICHOLAS C (PHD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:C
Last Name:WINTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 FLORAL VALE BLVD
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-5529
Mailing Address - Country:US
Mailing Address - Phone:215-860-8734
Mailing Address - Fax:215-860-2833
Practice Address - Street 1:706 FLORAL VALE BLVD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-5529
Practice Address - Country:US
Practice Address - Phone:215-860-8734
Practice Address - Fax:215-860-2833
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002433L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA184012Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST