Provider Demographics
NPI:1487664223
Name:WEINER, JAMES MICHAEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:WEINER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 W JACKSON BLVD
Mailing Address - Street 2:SUITE 7 WEST
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-3024
Mailing Address - Country:US
Mailing Address - Phone:312-455-8904
Mailing Address - Fax:312-455-8921
Practice Address - Street 1:900 W JACKSON BLVD
Practice Address - Street 2:SUITE 7 WEST
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-3024
Practice Address - Country:US
Practice Address - Phone:312-455-8904
Practice Address - Fax:312-455-8921
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist