Provider Demographics
NPI:1346680238
Name:WEINER, TALIA ROSE (MA)
Entity Type:Individual
Prefix:
First Name:TALIA
Middle Name:ROSE
Last Name:WEINER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5521 S CORNELL AVE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1914
Mailing Address - Country:US
Mailing Address - Phone:708-681-2325
Mailing Address - Fax:
Practice Address - Street 1:9845 W ROOSEVELT RD
Practice Address - Street 2:5841 S. MARYLAND AVENUE
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-2758
Practice Address - Country:US
Practice Address - Phone:708-681-2325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health