Provider Demographics
NPI:1881742906
Name:WINFIELD, EVELYN BEATRICE (PHD)
Entity type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:BEATRICE
Last Name:WINFIELD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22022 BLUEBIRD AVE
Mailing Address - Street 2:
Mailing Address - City:MATTAWAN
Mailing Address - State:MI
Mailing Address - Zip Code:49071-8723
Mailing Address - Country:US
Mailing Address - Phone:269-491-6760
Mailing Address - Fax:269-668-6694
Practice Address - Street 1:576 ROMENCE RD
Practice Address - Street 2:SUITE 222
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-3472
Practice Address - Country:US
Practice Address - Phone:269-491-6760
Practice Address - Fax:269-668-6696
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010384103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIQ04056Medicare ID - Type Unspecified