Provider Demographics
NPI:1821234618
Name:WINEBRENNER, LAURA KAY (MSW)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:KAY
Last Name:WINEBRENNER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 WHITFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-1213
Mailing Address - Country:US
Mailing Address - Phone:617-623-8216
Mailing Address - Fax:
Practice Address - Street 1:33 WHITFIELD RD
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-1213
Practice Address - Country:US
Practice Address - Phone:617-623-8216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-28
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101949104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA70010000P03427OtherBLUE CROSS BLUE SHIELD
MA70010000PO3427OtherBLUE CROSS BLUE SHIELD