Provider Demographics
NPI:1881838076
Name:WEINSOCK, JERRY ALLAN (MA, LMHC)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:ALLAN
Last Name:WEINSOCK
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 W 34TH ST.
Mailing Address - Street 2:12TH FLOOR YAI/NIPD
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001
Mailing Address - Country:US
Mailing Address - Phone:212-273-6187
Mailing Address - Fax:212-273-6536
Practice Address - Street 1:460 W 34TH STREET
Practice Address - Street 2:12TH FLOOR YAI/NIPD
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-2382
Practice Address - Country:US
Practice Address - Phone:212-273-6187
Practice Address - Fax:212-273-6536
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004057101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health