Provider Demographics
NPI:1649418005
Name:WEINGEROFF, JOLIE (PHD)
Entity Type:Individual
Prefix:
First Name:JOLIE
Middle Name:
Last Name:WEINGEROFF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JOLIE
Other - Middle Name:
Other - Last Name:ISSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:11 S ANGELL ST # 405
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5206
Mailing Address - Country:US
Mailing Address - Phone:401-330-5882
Mailing Address - Fax:401-226-0137
Practice Address - Street 1:382 THAYER ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-1558
Practice Address - Country:US
Practice Address - Phone:401-330-5882
Practice Address - Fax:401-226-0137
Is Sole Proprietor?:No
Enumeration Date:2009-01-23
Last Update Date:2021-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019636103TC0700X
RIPS01616103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical