Provider Demographics
NPI:1871028233
Name:WIENER, JEREMY (MSW, LCSW-C)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:WIENER
Suffix:
Gender:M
Credentials:MSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4848 BATTERY LN
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-2709
Mailing Address - Country:US
Mailing Address - Phone:202-670-5668
Mailing Address - Fax:
Practice Address - Street 1:4848 BATTERY LN
Practice Address - Street 2:SUITE 202
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2709
Practice Address - Country:US
Practice Address - Phone:202-670-5668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD181891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical