Provider Demographics
NPI:1164582888
Name:WEINER, WENDY A (PHD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:A
Last Name:WEINER
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 1:121 KNOLLWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ASTON
Mailing Address - State:PA
Mailing Address - Zip Code:19014-1259
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:26 SUMMIT GROVE AVE
Practice Address - Street 2:STE 207
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3230
Practice Address - Country:US
Practice Address - Phone:610-825-1444
Practice Address - Fax:610-358-4985
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008665L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0165984000OtherBLUE CROSS
PA378351OtherBLUE SHIELD
PA7149479OtherAETNA
PA018438Medicare ID - Type Unspecified