Provider Demographics
NPI:1083012744
Name:WAINMAN, JEANEEN
Entity Type:Individual
Prefix:MRS
First Name:JEANEEN
Middle Name:
Last Name:WAINMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4039 WINDWARD DR
Mailing Address - Street 2:
Mailing Address - City:TEGA CAY
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8509
Mailing Address - Country:US
Mailing Address - Phone:803-389-7205
Mailing Address - Fax:
Practice Address - Street 1:4039 WINDWARD DR
Practice Address - Street 2:
Practice Address - City:TEGA CAY
Practice Address - State:SC
Practice Address - Zip Code:29708-8509
Practice Address - Country:US
Practice Address - Phone:803-389-7205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-11
Last Update Date:2014-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst