Provider Demographics
NPI:1710112487
Name:WEINGARTEN, NICOLE LEIGH (MS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LEIGH
Last Name:WEINGARTEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2490 HONOLULU AVE
Mailing Address - Street 2:SUITE 135
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1800
Mailing Address - Country:US
Mailing Address - Phone:818-249-5690
Mailing Address - Fax:818-249-1429
Practice Address - Street 1:2490 HONOLULU AVE
Practice Address - Street 2:SUITE 135
Practice Address - City:MONTROSE
Practice Address - State:CA
Practice Address - Zip Code:91020-1800
Practice Address - Country:US
Practice Address - Phone:818-249-5690
Practice Address - Fax:818-249-1429
Is Sole Proprietor?:No
Enumeration Date:2009-05-23
Last Update Date:2009-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36647106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist