Psycare of the Triad, LLP

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

PSYCARE OF THE TRIAD, LLP

Practice address

661 Hartman St
Winston Salem, NC 27127-7126

Phone

(336) 413-3026

Fax

(336) 413-3026

NPI assigned

Aug 10, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Deborea Winfrey, PHDNPI 1275527459

Title

Clinical Director

Phone

(336) 682-7432

Specialties & licenses 1

Addresses

Other identifiers 6

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Deborea Williams Winfrey, PHD

  • Psychologist
  • Winston Salem, NC
  • NPI 1275527459
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274313600000",
    "number": "1720099385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "661 HARTMAN ST",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271277126",
            "telephone_number": "336-413-3026",
            "fax_number": "336-413-3026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "661 HARTMAN ST",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271277126",
            "telephone_number": "336-413-3026",
            "fax_number": "336-413-3026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCARE OF THE TRIAD, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2010-05-20",
        "status": "A",
        "authorized_official_last_name": "WINFREY",
        "authorized_official_first_name": "DEBOREA",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "336-682-7432",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301783H",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "600568",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301783G",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6005108",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301783B",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "02884",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Michael Pucciariello
• Nicole Puccinelli-Ortega, MS, NBC-HWC

• Mental Health Clinic/Center (Including Community Mental Health Center) in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.