Provider Demographics
NPI:1275895070
Name:WEINER, STEPHEN ANTHONY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ANTHONY
Last Name:WEINER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 W MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-2180
Mailing Address - Country:US
Mailing Address - Phone:215-752-3268
Mailing Address - Fax:215-752-1983
Practice Address - Street 1:241 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-2180
Practice Address - Country:US
Practice Address - Phone:215-752-3268
Practice Address - Fax:215-752-1983
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004119L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical