Provider Demographics
NPI:1194777607
Name:WINIKOFF, MIRIAM G (MED)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:G
Last Name:WINIKOFF
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 SHADY AVE
Mailing Address - Street 2:D106
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-4409
Mailing Address - Country:US
Mailing Address - Phone:412-661-3352
Mailing Address - Fax:412-661-3352
Practice Address - Street 1:401 SHADY AVE
Practice Address - Street 2:D106
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-4409
Practice Address - Country:US
Practice Address - Phone:412-661-3352
Practice Address - Fax:412-661-3352
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005217L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA002598OtherHIGHMARK BC/BS NUMBER