Provider Demographics
NPI:1003919283
Name:WEINER, EUGENE CHIP (LMHC)
Entity Type:Individual
Prefix:MR
First Name:EUGENE CHIP
Middle Name:
Last Name:WEINER
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3202 HENDERSON BLVD STE 100A
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-3043
Mailing Address - Country:US
Mailing Address - Phone:813-414-9900
Mailing Address - Fax:813-414-9900
Practice Address - Street 1:3202 HENDERSON BLVD
Practice Address - Street 2:100A
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2550
Practice Address - Country:US
Practice Address - Phone:813-414-9900
Practice Address - Fax:813-414-9900
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 4746101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20-5043256OtherTIN