Provider Demographics
NPI:1013446830
Name:WINTERS, LENA ROSE
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:ROSE
Last Name:WINTERS
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 1:2488 N BEACHWOOD DR APT 3
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-3396
Mailing Address - Country:US
Mailing Address - Phone:323-630-5957
Mailing Address - Fax:
Practice Address - Street 1:2488 N BEACHWOOD DR APT 3
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-3396
Practice Address - Country:US
Practice Address - Phone:323-630-5957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-06
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0895021041C0700X
CA1079651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical