Provider Demographics
NPI:1972815801
Name:WINICK, ANDREW B (PSYD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:B
Last Name:WINICK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 WILSON CT
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3531
Mailing Address - Country:US
Mailing Address - Phone:516-295-1640
Mailing Address - Fax:516-295-1640
Practice Address - Street 1:777 WILSON CT
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-3531
Practice Address - Country:US
Practice Address - Phone:516-295-1640
Practice Address - Fax:516-295-1640
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017878-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist