Provider Demographics
NPI:1003866922
Name:VINER, DEBRA CHARMAINE (PHD)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:CHARMAINE
Last Name:VINER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 W SUPERIOR ST
Mailing Address - Street 2:STE 1000
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-1818
Mailing Address - Country:US
Mailing Address - Phone:218-428-1175
Mailing Address - Fax:218-216-1452
Practice Address - Street 1:306 W SUPERIOR ST STE 1000
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1818
Practice Address - Country:US
Practice Address - Phone:218-481-7660
Practice Address - Fax:218-216-1452
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2023-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1868101Y00000X
MN1868103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN275252200Medicaid