Provider Demographics
NPI:1265442545
Name:WEIN, MERYL S (LCPC)
Entity Type:Individual
Prefix:
First Name:MERYL
Middle Name:S
Last Name:WEIN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:453 US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:KITTERY
Mailing Address - State:ME
Mailing Address - Zip Code:03904
Mailing Address - Country:US
Mailing Address - Phone:207-439-8391
Mailing Address - Fax:207-282-7509
Practice Address - Street 1:453 US ROUTE 1
Practice Address - Street 2:
Practice Address - City:KITTERY
Practice Address - State:ME
Practice Address - Zip Code:03904-5513
Practice Address - Country:US
Practice Address - Phone:207-439-8391
Practice Address - Fax:207-439-4360
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC2600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional