Provider Demographics
NPI:1801363940
Name:WINCHEL, ALISA HARTMAN
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:HARTMAN
Last Name:WINCHEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 W 139TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-1508
Mailing Address - Country:US
Mailing Address - Phone:917-690-7234
Mailing Address - Fax:
Practice Address - Street 1:BLEULER PSYCHOTHERAPY CENTER
Practice Address - Street 2:104-70 QUEENS BLVD SUIT 220
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-275-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-26
Last Update Date:2020-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY099776-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty