Provider Demographics
NPI:1407069305
Name:WEINER, BARRY STEPHEN (LCSW-C , LCADC)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:STEPHEN
Last Name:WEINER
Suffix:
Gender:M
Credentials:LCSW-C , LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5112 LEEDS AVE.
Mailing Address - Street 2:
Mailing Address - City:HALETHORPE
Mailing Address - State:MD
Mailing Address - Zip Code:21227
Mailing Address - Country:US
Mailing Address - Phone:410-247-0364
Mailing Address - Fax:
Practice Address - Street 1:5560 STERRET PLACE
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044
Practice Address - Country:US
Practice Address - Phone:410-995-5555
Practice Address - Fax:410-995-5556
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD113231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical