Provider Demographics
NPI:1033669635
Name:CHRISTINE C WEILAND INC
Entity Type:Organization
Organization Name:CHRISTINE C WEILAND INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MISS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:WEILAND
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-881-4296
Mailing Address - Street 1:3114 NOSTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2601
Mailing Address - Country:US
Mailing Address - Phone:718-595-0540
Mailing Address - Fax:718-252-3964
Practice Address - Street 1:3114 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2601
Practice Address - Country:US
Practice Address - Phone:718-595-0540
Practice Address - Fax:718-252-3964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-06
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR03255211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04018920Medicaid
NYA300110160Medicare PIN