Provider Demographics
NPI:1093751521
Name:WEIS, DINA N (PHD)
Entity Type:Individual
Prefix:DR
First Name:DINA
Middle Name:N
Last Name:WEIS
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 1:300 PLAZA MIDDLESEX
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457
Mailing Address - Country:US
Mailing Address - Phone:860-347-9911
Mailing Address - Fax:860-347-8120
Practice Address - Street 1:300 PLAZA MIDDLESEX
Practice Address - Street 2:3RD FLOOR
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457
Practice Address - Country:US
Practice Address - Phone:860-347-9911
Practice Address - Fax:860-347-8120
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001810103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
163461OtherVALUE OPTIONS
738160OtherMAGELLAN
0992711OtherUHC
2059366OtherCIGNA
CT060001810CT02OtherBCBS
P740502OtherOXFORD
080233OtherMHN
CT4412392OtherAETNA
CT00413183500Medicaid
CT00413183500Medicaid