Provider Demographics
NPI:1821396672
Name:WINCHEL, LISSA DALE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LISSA
Middle Name:DALE
Last Name:WINCHEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 HOYT AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-2625
Mailing Address - Country:US
Mailing Address - Phone:917-846-5454
Mailing Address - Fax:
Practice Address - Street 1:426 HOYT AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-2625
Practice Address - Country:US
Practice Address - Phone:917-846-5454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07151111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical