Provider Demographics
NPI:1437882461
Name:WEISNER, SILVESTRO MENZANO (PHD, ABPP, CST)
Entity Type:Individual
Prefix:
First Name:SILVESTRO
Middle Name:MENZANO
Last Name:WEISNER
Suffix:
Gender:M
Credentials:PHD, ABPP, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10811 HOBSON ST
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-2216
Mailing Address - Country:US
Mailing Address - Phone:703-868-4067
Mailing Address - Fax:
Practice Address - Street 1:1501 LANGSTON BLVD STE 102
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209-1109
Practice Address - Country:US
Practice Address - Phone:703-909-5101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003506103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical