Provider Demographics
NPI:1891708285
Name:WEINER, JEANNE H (LCSW)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:H
Last Name:WEINER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 DUANE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-4940
Mailing Address - Country:US
Mailing Address - Phone:845-639-0215
Mailing Address - Fax:
Practice Address - Street 1:20 DUANE AVE
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-4940
Practice Address - Country:US
Practice Address - Phone:845-639-0215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0365351101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN5V681Medicare ID - Type Unspecified