Provider Demographics
NPI:1952494577
Name:PETROSINO WINNE, JEAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:
Last Name:PETROSINO WINNE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-4819
Mailing Address - Country:US
Mailing Address - Phone:315-246-4032
Mailing Address - Fax:315-255-1965
Practice Address - Street 1:5 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-4819
Practice Address - Country:US
Practice Address - Phone:315-246-4032
Practice Address - Fax:315-255-1965
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0625911041C0700X
NY0748391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical