Provider Demographics
NPI:1891974812
Name:WEIER O'PHINNEY, JENNIFER JOELLE (MA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JOELLE
Last Name:WEIER O'PHINNEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 TALCOTT RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-2089
Mailing Address - Country:US
Mailing Address - Phone:802-876-1100
Mailing Address - Fax:802-876-1101
Practice Address - Street 1:183 TALCOTT RD
Practice Address - Street 2:SUITE 206
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-2089
Practice Address - Country:US
Practice Address - Phone:802-876-1100
Practice Address - Fax:802-876-1101
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-26
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT047-0000728103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling