Provider Demographics
NPI:1053931113
Name:LEVY, WINNIEFRED LOUIS (OWNER)
Entity type:Individual
Prefix:
First Name:WINNIEFRED
Middle Name:LOUIS
Last Name:LEVY
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 DONALD RD APT 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02124-2751
Mailing Address - Country:US
Mailing Address - Phone:857-869-8727
Mailing Address - Fax:617-506-1086
Practice Address - Street 1:25 DONALD RD APT 2
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02124-2751
Practice Address - Country:US
Practice Address - Phone:857-869-8727
Practice Address - Fax:617-506-1086
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-19
Last Update Date:2020-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA843975021251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health