Provider Demographics
NPI:1336433846
Name:SOURES, WINELL JENETTA (LCSW-R, SAP, MSW,MA)
Entity Type:Individual
Prefix:MS
First Name:WINELL
Middle Name:JENETTA
Last Name:SOURES
Suffix:
Gender:F
Credentials:LCSW-R, SAP, MSW,MA
Other - Prefix:MRS
Other - First Name:WINELL
Other - Middle Name:JENETTA
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-R, SAP
Mailing Address - Street 1:650 WARREN ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-2998
Mailing Address - Country:US
Mailing Address - Phone:518-462-6531
Mailing Address - Fax:518-462-0181
Practice Address - Street 1:650 WARREN ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-2998
Practice Address - Country:US
Practice Address - Phone:518-462-6531
Practice Address - Fax:518-462-0181
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25106101YA0400X
NY087957-011041C0700X
NYR087957-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)