Provider Demographics
NPI:1104997899
Name:KENNY WINICK, MAUREEN CHRISTINA (PHD)
Entity type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:CHRISTINA
Last Name:KENNY WINICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:10400 GRIFFIN ROAD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328
Mailing Address - Country:US
Mailing Address - Phone:954-830-0976
Mailing Address - Fax:954-433-0603
Practice Address - Street 1:10000 STIRLING RD
Practice Address - Street 2:SUITE 6
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33024
Practice Address - Country:US
Practice Address - Phone:954-830-0976
Practice Address - Fax:954-433-0603
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2012-12-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPY0005298103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54095Medicare ID - Type Unspecified