Provider Demographics
NPI:1437397858
Name:WEINER, ELANA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ELANA
Middle Name:
Last Name:WEINER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 MOUNT VERNON ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02465-2517
Mailing Address - Country:US
Mailing Address - Phone:617-558-5517
Mailing Address - Fax:
Practice Address - Street 1:508A HARVARD STREET
Practice Address - Street 2:#4
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-2934
Practice Address - Country:US
Practice Address - Phone:617-272-1633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7376103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical