Provider Demographics
NPI:1902686017
Name:WINTER, JAKE W (BS)
Entity Type:Individual
Prefix:MR
First Name:JAKE
Middle Name:W
Last Name:WINTER
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2744 MERCER RD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-1453
Mailing Address - Country:US
Mailing Address - Phone:724-944-4612
Mailing Address - Fax:
Practice Address - Street 1:2710 W STATE ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-8644
Practice Address - Country:US
Practice Address - Phone:724-598-7999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)