Provider Demographics
NPI:1457415564
Name:WINDINGLAND, GUY (LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:GUY
Middle Name:
Last Name:WINDINGLAND
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MAIN ST.
Mailing Address - Street 2:SUITE 5
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850
Mailing Address - Country:US
Mailing Address - Phone:607-323-4110
Mailing Address - Fax:607-323-4109
Practice Address - Street 1:300 MAIN ST.
Practice Address - Street 2:SUITE 5
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850
Practice Address - Country:US
Practice Address - Phone:607-323-4110
Practice Address - Fax:607-323-4109
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYR03395111041C0700X
NYR033951-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYIA0938Medicare UPIN