Provider Demographics
NPI:1295046191
Name:WIEDER, ANNETTE ROBIN (MS ED)
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:ROBIN
Last Name:WIEDER
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 COLONADE RD
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-3102
Mailing Address - Country:US
Mailing Address - Phone:516-539-1614
Mailing Address - Fax:
Practice Address - Street 1:626 COLONADE RD
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-3102
Practice Address - Country:US
Practice Address - Phone:516-539-1614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool