Provider Demographics
NPI:1285640193
Name:WEINSTEIN, MARC JONATHAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:JONATHAN
Last Name:WEINSTEIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2360 W JOPPA RD
Mailing Address - Street 2:SUITE 219
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4624
Mailing Address - Country:US
Mailing Address - Phone:410-769-8585
Mailing Address - Fax:410-769-8585
Practice Address - Street 1:2360 W JOPPA ROAD
Practice Address - Street 2:# 219
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4624
Practice Address - Country:US
Practice Address - Phone:410-769-8585
Practice Address - Fax:410-769-8585
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04074103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist