Provider Demographics
NPI:1215188677
Name:WIENER, ELIZABETH MERRILL
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:MERRILL
Last Name:WIENER
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 1:50 E HARTSDALE AVE
Mailing Address - Street 2:APT 5P
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-2725
Mailing Address - Country:US
Mailing Address - Phone:516-972-4863
Mailing Address - Fax:
Practice Address - Street 1:70 GRAND ST
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5606
Practice Address - Country:US
Practice Address - Phone:914-636-5231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health