Provider Demographics
NPI:1790276129
Name:WINKLEVOSS, JILLIAN K (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:K
Last Name:WINKLEVOSS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 E WALLACE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-2453
Mailing Address - Country:US
Mailing Address - Phone:724-654-9555
Mailing Address - Fax:724-498-0976
Practice Address - Street 1:143 E WALLACE AVE
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-2453
Practice Address - Country:US
Practice Address - Phone:724-654-9555
Practice Address - Fax:724-498-0976
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW133876104100000X
OHS.1700064104100000X
PACW0221551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker