Provider Demographics
NPI:1245699677
Name:WYNTER, CARMEN D
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:D
Last Name:WYNTER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CARMEN
Other - Middle Name:D
Other - Last Name:LUGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:332 CAMPFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06114-2803
Mailing Address - Country:US
Mailing Address - Phone:860-878-1173
Mailing Address - Fax:
Practice Address - Street 1:255 PITKIN ST
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-3255
Practice Address - Country:US
Practice Address - Phone:860-289-6496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician