Provider Demographics
NPI:1306058763
Name:MARTINKOVIC, WINNIE M (PSYD)
Entity type:Individual
Prefix:DR
First Name:WINNIE
Middle Name:M
Last Name:MARTINKOVIC
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 POMPERAUG OFFICE PARK
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2288
Mailing Address - Country:US
Mailing Address - Phone:203-267-7979
Mailing Address - Fax:203-267-7979
Practice Address - Street 1:2 POMPERAUG OFFICE PARK
Practice Address - Street 2:SUITE 202
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2288
Practice Address - Country:US
Practice Address - Phone:203-267-7979
Practice Address - Fax:203-267-7979
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001937103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT163014OtherCIGNA
CT163014OtherVALUE OPTIONS
CTIP295360OtherCONNECTICARE
CTIP261542OtherMAGELLAN
CT060001937CT03OtherANTHEM BLUE CROSS BLUE SH
CT175371OtherMHN
CTP2743360OtherOXFORD