Provider Demographics
NPI:1255405932
Name:WIJNBERG, ELLEN E (LCSW)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:E
Last Name:WIJNBERG
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 1:6600 UNIVERSITY PKWY STE 304
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-9048
Mailing Address - Country:US
Mailing Address - Phone:833-769-3524
Mailing Address - Fax:
Practice Address - Street 1:6600 UNIVERSITY PKWY STE 304
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-9048
Practice Address - Country:US
Practice Address - Phone:833-769-3524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0056291041C0700X
FLSW49671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical