Provider Demographics
NPI:1417097494
Name:WEINBERG, PEGGY GRITTER (MA,LLP)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:GRITTER
Last Name:WEINBERG
Suffix:
Gender:F
Credentials:MA,LLP
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:J
Other - Last Name:MIEDEMA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA,PC
Mailing Address - Street 1:3839 OLD CREEK RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-1659
Mailing Address - Country:US
Mailing Address - Phone:248-930-3994
Mailing Address - Fax:
Practice Address - Street 1:700 N OLD WOODWARD AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-1322
Practice Address - Country:US
Practice Address - Phone:248-642-8263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007956103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical