Provider Demographics
NPI:1730937178
Name:WINER, LOWELL (LMFT)
Entity type:Individual
Prefix:
First Name:LOWELL
Middle Name:
Last Name:WINER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 INDIANA AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-3057
Mailing Address - Country:US
Mailing Address - Phone:949-632-2167
Mailing Address - Fax:310-388-0537
Practice Address - Street 1:618 INDIANA AVE APT 4
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-3057
Practice Address - Country:US
Practice Address - Phone:424-218-6505
Practice Address - Fax:310-388-0537
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA145703106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist