Provider Demographics
NPI:1447579693
Name:WEINER, MARIA REGINA (LPE-I)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:REGINA
Last Name:WEINER
Suffix:
Gender:F
Credentials:LPE-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 TOWER LN
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-7190
Mailing Address - Country:US
Mailing Address - Phone:870-245-2563
Mailing Address - Fax:
Practice Address - Street 1:2506 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-2930
Practice Address - Country:US
Practice Address - Phone:870-230-8217
Practice Address - Fax:870-230-8201
Is Sole Proprietor?:No
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR80-20EI103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist