Provider Demographics
NPI:1013353515
Name:WINAKOR, MICHAEL WILLIAM (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:WILLIAM
Last Name:WINAKOR
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-5246
Mailing Address - Country:US
Mailing Address - Phone:860-578-4808
Mailing Address - Fax:866-355-1052
Practice Address - Street 1:117 E CENTER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-5246
Practice Address - Country:US
Practice Address - Phone:860-578-4808
Practice Address - Fax:866-355-1052
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-12
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8989101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1013353515OtherNPI