Provider Demographics
NPI:1528515756
Name:WINEBRENNER, ELIZABETH H (BCBA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:H
Last Name:WINEBRENNER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:H
Other - Last Name:WINEBRENNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:377 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-4311
Mailing Address - Country:US
Mailing Address - Phone:203-693-4533
Mailing Address - Fax:203-306-3137
Practice Address - Street 1:377 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-4311
Practice Address - Country:US
Practice Address - Phone:203-693-4533
Practice Address - Fax:203-306-3137
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1-15-18466103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst