Provider Demographics
NPI:1366476459
Name:WEINER, STEVEN MARK (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:MARK
Last Name:WEINER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12024 SPRUCE HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-4822
Mailing Address - Country:US
Mailing Address - Phone:314-872-9379
Mailing Address - Fax:
Practice Address - Street 1:10420 OLD OLIVE ST RD
Practice Address - Street 2:SUITE 209
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-5938
Practice Address - Country:US
Practice Address - Phone:314-567-9321
Practice Address - Fax:314-567-7355
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY01139103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO27247OtherBLUE CROSS BLUE SHIELD