Provider Demographics
NPI:1508972845
Name:WIENER, CRAIG B (EDD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:B
Last Name:WIENER
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 WILLIAM ST
Mailing Address - Street 2:SOCIAL SERVICES
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-2136
Mailing Address - Country:US
Mailing Address - Phone:508-756-4825
Mailing Address - Fax:508-860-7990
Practice Address - Street 1:48 CEDAR ST.
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:00109-0010
Practice Address - Country:US
Practice Address - Phone:508-756-4825
Practice Address - Fax:508-792-3519
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2580103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1001040OtherBEAON HEALTH STATEGIES
MA1300709Medicaid
MA24846OtherCIGNA
MAW02706OtherBLUE CROSS BLUE SHIELD
MA986777801OtherNETWORK HEALTH
MA052178000OtherMAGELLAN BEHAVIORAL HEALT
MA1001250OtherBEACON-GROUP
MA716664OtherTUFTS HEALTH PLAN
MA0300050Medicaid
MA042485308OtherNETWORK HEALTH-GROUP
MAY10141OtherBCBS-GROUP
MA0508977OtherMEDICAID
MAW10560OtherBCBS
MA24846OtherCIGNA
MA0508977OtherMEDICAID
MA1001040OtherBEAON HEALTH STATEGIES
MAW02706Medicare Oscar/Certification
MAW02706Medicare UPIN