Provider Demographics
NPI:1851572598
Name:WEINBERG, MICHAEL
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:WEINBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:WEINBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:65 E NASA BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1961
Mailing Address - Country:US
Mailing Address - Phone:321-541-1972
Mailing Address - Fax:321-372-1041
Practice Address - Street 1:65 E NASA BLVD STE 101
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1961
Practice Address - Country:US
Practice Address - Phone:321-541-1972
Practice Address - Fax:321-372-1041
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-23
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002562103T00000X, 103TM1800X
PAPS005339L103T00000X, 103TB0200X, 103TM1800X
103T00000X
CT002562C103TB0200X
FLPY10415103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
1851572598OtherDON'T KNOW