Provider Demographics
NPI:1649255696
Name:WEINGARTEN, CHARLES JAY (PHD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JAY
Last Name:WEINGARTEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13400 RIVERSIDE DR
Mailing Address - Street 2:#310
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-2544
Mailing Address - Country:US
Mailing Address - Phone:818-788-7153
Mailing Address - Fax:818-386-9084
Practice Address - Street 1:13400 RIVERSIDE DR
Practice Address - Street 2:#310
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-2544
Practice Address - Country:US
Practice Address - Phone:818-788-7153
Practice Address - Fax:818-386-9084
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY4170103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP4170Medicare ID - Type Unspecified