Provider Demographics
NPI:1073825394
Name:WEINBACH, VANESSA CAMILLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:CAMILLE
Last Name:WEINBACH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 RIVERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-1306
Mailing Address - Country:US
Mailing Address - Phone:203-343-4208
Mailing Address - Fax:203-350-8286
Practice Address - Street 1:6 RIVERFIELD DR
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-1306
Practice Address - Country:US
Practice Address - Phone:203-343-4208
Practice Address - Fax:203-350-8286
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-02
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22525103TC0700X
CT3681103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical