Provider Demographics
NPI:1023031945
Name:WEINER, ROBERTA DANITZ (LSW)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:DANITZ
Last Name:WEINER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 GREENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602
Mailing Address - Country:US
Mailing Address - Phone:814-944-7961
Mailing Address - Fax:814-944-3373
Practice Address - Street 1:122 GREENWOOD RD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-7125
Practice Address - Country:US
Practice Address - Phone:814-944-7961
Practice Address - Fax:814-944-3373
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0156111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical