Provider Demographics
NPI:1710262589
Name:WEINBERG, BETH ANDREA (PHD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:ANDREA
Last Name:WEINBERG
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 1:201 EAST SAMPLE RD.
Mailing Address - Street 2:QUANTUM LABORATORIES AT BHN MEMORY CENTER
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064
Mailing Address - Country:US
Mailing Address - Phone:305-587-3961
Mailing Address - Fax:
Practice Address - Street 1:3440 HOLLYWOOD BLVD.
Practice Address - Street 2:SUITE 415
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021
Practice Address - Country:US
Practice Address - Phone:305-587-3961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2017-12-08
Deactivation Date:2013-03-29
Deactivation Code:
Reactivation Date:2017-04-28
Provider Licenses
StateLicense IDTaxonomies
FLPY8206103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical