Provider Demographics
NPI:1114086980
Name:DIANE WEINER PHD, L.L.C.
Entity Type:Organization
Organization Name:DIANE WEINER PHD, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:WEINER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:608-274-4487
Mailing Address - Street 1:715 HILL ST
Mailing Address - Street 2:SUITE 270
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-3542
Mailing Address - Country:US
Mailing Address - Phone:608-274-4487
Mailing Address - Fax:
Practice Address - Street 1:715 HILL ST
Practice Address - Street 2:SUITE 270
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-3542
Practice Address - Country:US
Practice Address - Phone:608-274-4487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2058057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIS74834Medicare UPIN