Provider Demographics
NPI:1760539498
Name:WINARICK, KENNETH BARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:BARD
Last Name:WINARICK
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 1:220 E 63RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-7660
Mailing Address - Country:US
Mailing Address - Phone:917-369-1721
Mailing Address - Fax:917-369-1721
Practice Address - Street 1:220 E 63RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-7660
Practice Address - Country:US
Practice Address - Phone:917-369-1721
Practice Address - Fax:917-369-1721
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005195103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVS0471Medicare ID - Type Unspecified