Provider Demographics
NPI:1295320737
Name:WEINSTEIN, JUSTIN (MS)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:WEINSTEIN
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13512 MIRROR LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7421
Mailing Address - Country:US
Mailing Address - Phone:727-900-5289
Mailing Address - Fax:
Practice Address - Street 1:315 N WYMORE RD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2822
Practice Address - Country:US
Practice Address - Phone:727-900-5289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-06
Last Update Date:2021-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH20648101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health