Provider Demographics
NPI:1710614037
Name:MAIRIN WEINER LICENSED CLINICAL SOCIAL WORKER
Entity Type:Organization
Organization Name:MAIRIN WEINER LICENSED CLINICAL SOCIAL WORKER
Other - Org Name:MIDDLE PATH THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAIRIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:415-312-5454
Mailing Address - Street 1:676 CHENERY ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-3034
Mailing Address - Country:US
Mailing Address - Phone:415-312-5454
Mailing Address - Fax:
Practice Address - Street 1:676 CHENERY ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94131-3034
Practice Address - Country:US
Practice Address - Phone:415-312-5454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-05
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1487869079Medicaid