Provider Demographics
NPI:1841559457
Name:WEIN, STACY (JD,MS,LMHC)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:
Last Name:WEIN
Suffix:
Gender:F
Credentials:JD,MS,LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 ISLAND BLVD
Mailing Address - Street 2:APT. 3003
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4957
Mailing Address - Country:US
Mailing Address - Phone:305-926-2218
Mailing Address - Fax:954-467-1506
Practice Address - Street 1:2000 ISLAND BLVD
Practice Address - Street 2:APT. 3003
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33160-4957
Practice Address - Country:US
Practice Address - Phone:305-926-2218
Practice Address - Fax:954-467-1506
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4954101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health