Provider Demographics
NPI:1295210458
Name:WINSLOW, KATHERYN ELIZABETH
Entity type:Individual
Prefix:
First Name:KATHERYN
Middle Name:ELIZABETH
Last Name:WINSLOW
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 1:4145 PINELLA CIR APT 364
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6744
Mailing Address - Country:US
Mailing Address - Phone:386-795-4169
Mailing Address - Fax:
Practice Address - Street 1:123 NW 13TH ST STE 300A
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-1624
Practice Address - Country:US
Practice Address - Phone:561-261-9388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16260101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health