Provider Demographics
NPI:1083604862
Name:SCHRIESHEIM, DEWIE WEINER (MS)
Entity Type:Individual
Prefix:MS
First Name:DEWIE
Middle Name:WEINER
Last Name:SCHRIESHEIM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:DEWIE
Other - Middle Name:
Other - Last Name:WEINER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:4 DOVER LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-6100
Mailing Address - Country:US
Mailing Address - Phone:781-861-7585
Mailing Address - Fax:781-862-2591
Practice Address - Street 1:76 BEDFORD ST
Practice Address - Street 2:SUITE 19
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4646
Practice Address - Country:US
Practice Address - Phone:781-861-7585
Practice Address - Fax:781-862-2591
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2010-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1021771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAWEP01344OtherBLUE CROSS BLUE SHIELD
MAWEP20594Medicare ID - Type UnspecifiedSOCIAL WORKER