Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 015423 | NY |
Y | 103T00000X | Psychologist | 015423 | NY |
NPI | 1013340322 |
---|---|
Provider Name | Lance Winslow |
First Address | Brooklyn, NY 11203-2054 |
Second Address | Brooklyn, NY 11203-2054 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2013 |
Last Update Date | 11/08/2013 |