Provider Demographics
NPI:1265048466
Name:WIENER, MOSHE (LMSW)
Entity type:Individual
Prefix:MR
First Name:MOSHE
Middle Name:
Last Name:WIENER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CAROLE LN
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-1230
Mailing Address - Country:US
Mailing Address - Phone:845-746-7522
Mailing Address - Fax:
Practice Address - Street 1:49 FOREST RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-2923
Practice Address - Country:US
Practice Address - Phone:845-782-3242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110378104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker