Provider Demographics
NPI:1972078012
Name:WINFIELD, MARKESE (BSW)
Entity type:Individual
Prefix:
First Name:MARKESE
Middle Name:
Last Name:WINFIELD
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:MARKESE
Other - Middle Name:L
Other - Last Name:WILLIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AS, BSW
Mailing Address - Street 1:4135 LUXEMBOURG CIR W
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46228-6754
Mailing Address - Country:US
Mailing Address - Phone:317-777-8635
Mailing Address - Fax:
Practice Address - Street 1:4135 LUXEMBOURG CIR W
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46228-6754
Practice Address - Country:US
Practice Address - Phone:317-777-8635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-16-12715106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
INRBT-16-12715OtherRBT