Provider Demographics
NPI:1821673401
Name:WINSLOW, AUTUMN (PHD)
Entity Type:Individual
Prefix:DR
First Name:AUTUMN
Middle Name:
Last Name:WINSLOW
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 JOHNSON AVE APT 3F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-1375
Mailing Address - Country:US
Mailing Address - Phone:860-287-4261
Mailing Address - Fax:
Practice Address - Street 1:223 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-3835
Practice Address - Country:US
Practice Address - Phone:860-287-4261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024190103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical