Provider Demographics
NPI:1770024960
Name:WINICK, CHARLES (PSYD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:WINICK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10400 GRIFFIN RD STE 101
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3320
Mailing Address - Country:US
Mailing Address - Phone:954-436-8326
Mailing Address - Fax:954-434-8572
Practice Address - Street 1:10400 GRIFFIN RD STE 101
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-3320
Practice Address - Country:US
Practice Address - Phone:954-436-8326
Practice Address - Fax:954-434-8572
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004966103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic