Provider Demographics
NPI:1033138193
Name:WEINHOLD, PAUL M (PHD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:M
Last Name:WEINHOLD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 N STATION PLZ
Mailing Address - Street 2:SUITE 307
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5011
Mailing Address - Country:US
Mailing Address - Phone:516-466-8330
Mailing Address - Fax:516-773-6017
Practice Address - Street 1:45 N STATION PLZ
Practice Address - Street 2:SUITE 307
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5011
Practice Address - Country:US
Practice Address - Phone:516-466-8330
Practice Address - Fax:516-773-6017
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5822103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV13231Medicare UPIN