Provider Demographics
NPI:1700191863
Name:LORRAINE WINCOR P.A.
Entity Type:Organization
Organization Name:LORRAINE WINCOR P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WINCOR
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-772-6015
Mailing Address - Street 1:3200 PORT ROYALE DR.
Mailing Address - Street 2:# 1203
Mailing Address - City:FT. LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-7805
Mailing Address - Country:US
Mailing Address - Phone:954-772-6015
Mailing Address - Fax:954-772-6099
Practice Address - Street 1:3200 PORT ROYALE DR
Practice Address - Street 2:# 1203
Practice Address - City:FT. LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-7805
Practice Address - Country:US
Practice Address - Phone:954-772-6015
Practice Address - Fax:954-772-6099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0003464103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty