Provider Demographics
NPI:1750391017
Name:WINEMAN, DORIS (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:DORIS
Middle Name:
Last Name:WINEMAN
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 E CHICAGO AVE APT 42F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-6677
Mailing Address - Country:US
Mailing Address - Phone:312-944-2870
Mailing Address - Fax:
Practice Address - Street 1:161 E CHICAGO AVE
Practice Address - Street 2:42F
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2601
Practice Address - Country:US
Practice Address - Phone:312-944-2870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001671549OtherBCBS