Basic Information
| Provider Information | |||||||||
| NPI: | 1386091635 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WINDSOR | ||||||||
| FirstName: | JACOB | ||||||||
| MiddleName: | NORMAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6040 PUBLIC LANDING RD | ||||||||
| Address2: | |||||||||
| City: | SNOW HILL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218632453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106321100 | ||||||||
| FaxNumber: | 4106325682 | ||||||||
| Practice Location | |||||||||
| Address1: | 11827 OCEAN GTWY | ||||||||
| Address2: | |||||||||
| City: | OCEAN CITY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218429529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102130202 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2016 | ||||||||
| LastUpdateDate: | 05/17/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | ADT1184 | MD | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.