Provider Demographics
NPI:1639395312
Name:WEINER, RAINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:RAINE
Middle Name:
Last Name:WEINER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6208 WAGNER LN
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20816-1029
Mailing Address - Country:US
Mailing Address - Phone:301-738-2078
Mailing Address - Fax:301-738-1636
Practice Address - Street 1:110 N WASHINGTON ST
Practice Address - Street 2:SUITE 407
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-2223
Practice Address - Country:US
Practice Address - Phone:301-738-2078
Practice Address - Fax:301-738-1636
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02438103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist