Individual
ELLIOTT WINCELE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
165 LANCASTER STREET, PORTLAND, ME 04101-2406
(207) 842-1030
(207) 874-1044
Mailing address
78 ATLANTIC PLACE, SOUTH PORTLAND, ME 04106-2316
(207) 842-7701
(207) 842-7773
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LC5183
ME
1041C0700X
Clinical Social Worker
Primary
LC5183
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
290380099
—
ME
Enumeration date
06/26/2006
Last updated
10/10/2012
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