Provider Demographics
NPI:1689683120
Name:WEINTRAUB, DONNA M (LICSW)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:M
Last Name:WEINTRAUB
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 COLONIAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02460
Mailing Address - Country:US
Mailing Address - Phone:617-964-9644
Mailing Address - Fax:617-332-7991
Practice Address - Street 1:38 COLONIAL AVENUE
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02460
Practice Address - Country:US
Practice Address - Phone:617-964-9644
Practice Address - Fax:617-332-7991
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1051021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA281454OtherMAGELLAN
MAP04204OtherBCBS
MA1892347OtherMBHP
MA281454OtherMAGELLAN