Provider Demographics
NPI:1225068547
Name:WEINSTEIN, CHERYL SHINBAUM (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:SHINBAUM
Last Name:WEINSTEIN
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 1:82 MARLBOROUGH STREET
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116
Mailing Address - Country:US
Mailing Address - Phone:617-327-3905
Mailing Address - Fax:617-323-2810
Practice Address - Street 1:82 MARLBOROUGH STREET
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116
Practice Address - Country:US
Practice Address - Phone:617-327-3905
Practice Address - Fax:617-323-2810
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
MAMA4836103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No174400000XOther Service ProvidersSpecialist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAWO4587Medicare UPIN