Provider Demographics
NPI:1043564222
Name:WEINER, CASEY ALLYN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:CASEY
Middle Name:ALLYN
Last Name:WEINER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-2526
Mailing Address - Country:US
Mailing Address - Phone:516-458-5156
Mailing Address - Fax:
Practice Address - Street 1:1329 BEACH CHANNEL DR
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-3211
Practice Address - Country:US
Practice Address - Phone:718-377-6850
Practice Address - Fax:347-246-9670
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-09
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY088747-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical